Request Form

Academic Request to Obtain Reputation Institute Results and/or Research Support

To be considered for Reputation Institute data, you must be a university professor or a Ph.D. student currently working your dissertation research.

Please fill in the following request form. Every field must be answered; where indicated, the given range of number of words per field must be strictly followed.

Please note that this request, if accepted, entitles you to discuss your research and possibility to receive a results from RI global research data sets such Global RepTrak™ Studies, RepTrak™ 100, CountryRep™ or CityRep™.

We require that all academic requests be submitted along with a Non-Disclosure Agreement (NDA), which must be signed by yourself and your supervisor. Additionally, we ask you to provide us with an electronic copy of the outcome of your research (e.g., Report, Article, Theses and dataset) upon its completion.

NDA can be submitted by email from your University address. Please print the Personal Code.

Create Personal Code:

Current year + first 3 letters of your university + first 3 letters of your last name. (e.g., James Smith from Syracuse University – 2012SYRSMI). This code will be used to link your submission with the signed NDA, which you will create below under your name on the NDA form.

* mandatory

What is today’s date? (mm/dd/yyyy) *

What is your Name: *

What is the highest degree you currently hold (e.g., BS, MS, Ph.D.): *

Is this request aimed at completing a Ph.D.? *

Yes
No (Ph.D. level is required to be considered for Reputation Institute data)

Name of your Department: *

Name of your Institution: *

Address of your Institution: *

Email: *
(Please submit your request using your university email address. RI will only consider requests from university email addresses.)

Phone Number: (###-###-####)*

What is the objective of your research (100-150 words): *

What Reputation Institute Data are you requesting? Include the time period: *

What is the expected date of this research completion?: *

Briefly, please describe the methodology deployed in the research (100-150 words): *

What is the Name of your Professor or department Chair: *

What is the URL of yours or your Professor’s website: *

Personal Code (see introduction): *

I confirm that the above information is correct. *
I confirm I have thoroughly read the requirements above and that this request DOES NOT entitle me to receive score-level data. *