For University Use Only

Complete the following form to request information from the Outreach database. You will be contacted shortly after the submission to confirm your request.  Please allow a minimum of three business days for your request to be completed.  If the information needed is for fund-raising purposes, you must contact GMU Foundation at 993-8756 to obtain approval of your request prior to completing this form.  If you have any questions, please email Dennis Kisielewski or call 993-8693.

Group(s) to be Included (Click here to view a list of groups contained in the outreach database.)

Other (Please list recognized organizations or groups only)

General Information to be Included (check all that apply)
Name        Mailing Address        Phone        Fax       Email

Format (check all that apply)
Labels (3 columns, 10 rows)      List (one column)
Windows Application  (e.g. Excel)

Medium (check all that apply)
Avery Labels       Paper       Diskette        Email

Special Instructions (i.e. font, sort order)

Date Request to be Completed    (mm/dd/yy)

Reason for Request (i.e. invitations, fliers, commencements)

Contact         

Department  

Mail Stop      

Email            

Extension     

FEEDBACK (optional)
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