Request to Access Restricted Data
Name:
Title:
Affiliation:
Email:
Phone:
List all researchers/students who will have access to the data:
First name
Last name
Project title:
Estimated project dates:
Research question:
How will the proposed research advance understanding of your area of study?
Analysis Plan:
55 Wyndham Street North, Suite 214A  Guelph, ON  N1H 7T8
T (519) 763-8049  T-Free: (877) 882-2204  F (519) 763-8521
[email protected]  www.greo.ca.
Please list your funding source(s):
I agree to comply with the Terms of Use
Please disclose any connections that any/all of those involved with the project may have to the gaming
industry or any private/public sector corporation, or any other group where a conflict of interest may be
created:
Dataset requested:
Do you need ethics clearance?
I agree to cite the authors of the dataset and the Gambling Research Exchange Ontario
_____________________________________________
Signature
_____________________________________________
Date signed
55 Wyndham Street North, Suite 214A  Guelph, ON  N1H 7T8
T (519) 763-8049  T-Free: (877) 882-2204  F (519) 763-8521
[email protected]  www.greo.ca.
FOR REVIEWERS:
Does this application comply with the Terms of Use for your dataset(s)?
Yes
No
Do you approve access to your dataset(s) for the researcher named above?
Yes
No
Comments or restrictions:
_____________________________________________
Reviewer’s signature
_____________________________________________
Date signed
55 Wyndham Street North, Suite 214A  Guelph, ON  N1H 7T8
T (519) 763-8049  T-Free: (877) 882-2204  F (519) 763-8521
[email protected]  www.greo.ca.