Request Forms

Requesting the Wellmark data requires four separate forms to be submitted to the CPHS.

1. The "Wellmark Data Request Form" must be completed for each project by the Principal Investigator (PI). Once all of the fields are correct, the PI should click "Submit by Email" to send the form for consideration.
2. The PI must also fill out the "Additional Eligible Users" form for any additional members of the project who need access to the data, taking care to use the same spelling and information as the corresponding primary form. Once all of the fields are correct, the PI should click "Submit by Email" to send the form for consideration.  Send as many "Additional Eligible Users" forms as necessary.
3. Submit a description of the project, how these data will be used, and the justification for needing these data to cph-cphsdata@uiowa.edu in a separate document (PDF or MS Word).  The document must be no more than three pages in length (can be single spaced).
4. Every member of the project team will need to complete and sign the "Individual User Agreement".  This agreement will ask the user to make two basic commitments: first to abide by the underlying Wellmark / UI agreement; second to abide by the policies that the UI has implemented.  Read the Individual User Agreement Terms of Usage page and then print and sign the Individual User Agreement.

On the Application Form and Eligible users Form you are asked to submit the forms via e-mail.  Please be sure your e-mail program is open before clicking the Submit by Email button.  Just click, and send the e-mail.  There will be an XML attachment that must be included.  The Individual User Agreement can be printed, signed, and mailed.  Please see the Process for Accessing Data page for more information on accessing and using the data. The PI will be contacted by Email with more information.

• Wellmark Data Request Form
• Additional Eligible Users Form
• Individual User Agreement Terms of Usage