Custom Data Search

An IYI staff person may contact you to clarify your needs before providing an answer to your question. Data requests should be submitted at least three working days before the information is needed. Some requests may take additional time, and a Data Team member will be happy to provide an estimate when this is the case. You may also fax this request form to (317) 396-2701, or mail it to Data Request, Indiana Youth Institute, 603 East Washington Street, Suite 800, Indianapolis, IN 46204.

 

All fields are required.
First Name:
Last Name:
Title:
Organization:
Address:
Address 2:
City:
State:
Zip:
County:
Phone with area code:
Fax with area code:
Email:
Is your organization a non-profit youth serving organization? YesNo
Date needed by:
Your Question:
Have you or your organization used IYI before? YesNoUnsure
How did you hear about this program or service?

IYI Weekly Update
Friend or Co-Worker
IYI Staff or Consultant
Media: Newspaper, Radio or TV
IYI Training, Presentation or Exhibit
IYI Web Site
Brochure from IYI
Other Web Site, ListServ, Newsletter
Other: