Please enter the following information. (Date Submitted and Date Needed should be entered. Click on the calendar icons to enter dates.)
*Please note the GIS team provides support to all of DSHS. Typically our turnaround time is within 5 business days.
[None] Date Needed:
What unit of DSHS is requesting this service?
How many records do you have? 1-100
What format do you want your output? dbf
Are these data confidential? yes
All data must be submitted in a separate email. Please send it in excel, access, csv, or dbf format to: firstname.lastname@example.org
If you need to submit confidential data, please complete this form and contact us for a secure ftp address at: email@example.com
field name field width field typestring/character
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