Office of Research Affairs: Data Use Agreement

To request a Data Use Agreement, please fill out all fields below.

PI INFORMATION

PI First Name

PI Last Name

PI Department

PI Phone

PI Email

DEPARTMENT PRIMARY CONTACT PERSON INFORMATION

Contact First Name

Contact Last Name

Contact Phone

Contact Email

OTHER PARTY INFORMATION (INSTITUTION/PARTY SENDING OR RECEIVING DATA)

Other Party Name

Other Party Contact Name

Other Party Street Address

Other Party City

Other Party State

Other Party ZIP/Postal Code

Other Party Country

Other Party Contact Phone

Other Party Contact Email

STUDY INFORMATION

Type of Agreement

Incoming DataOutgoing Data

IRB Protocol Number

Study Title

Will there be a payment(s) associated with the data sharing?

YesNo

Will Penn State University be making the payment(s)?

YesNo

Upload the Data Use Agreement received from the other party in Word document format: