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Williamson County and Cities Health District Data and Map Request Form
This form helps us understand your data request better to provide you the most accurate information, the way you want. Please answer all questions. Thank you!
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Email
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Your email
Name
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Your answer
Position/Title
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Your answer
Organization Name
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Your answer
Contact Number
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Your answer
Date of Request
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DD
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YYYY
Desired Completion Date
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MM
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YYYY
How will this data be used?
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Grant Proposal
Newspaper/Newsletter
Program Evaluation
Program Management
Presentation/Education
Other:
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In what format would you like to receive this data or analysis?
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Excel
Map
Report
Presentation
Other:
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Over what time period should data be provided or analysis be conducted? (ex. 2017 full calendar year, January 1st, 2016 to December 31st, 2018)
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Your answer
What variables are you interested in for this request? (Ex. gender, age, race, ethnicity, zip code)
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Your answer
Please provide more information about your request
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