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PsycINFO Request Form

For security reasons, you have 20 minutes to complete data entry and click the 'Submit' button. Please note: if the page does time out, your data will NOT be saved. If you need more than 20 minutes, we strongly recommend you compose your longer text in a word processor. Simply copy and paste your information in the appropriate places.
Researcher contact information:
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If this request is being made by an intermediary, please provide the intermediary's contact information:















Who should we contact to discuss this request?
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Characters remaining: 1000
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Characters remaining: 1000
Please list all other individuals who will have access to this data and provide the role and contact information for each:

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Person #2





Person #3





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Characters remaining: 1000
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Characters remaining: 1000