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DPI Data Use Agreement Modification

Enter the information below to submit a modification request for an existing Data Use Agreement (DUA) with the Wisconsin Department of Public Instruction.  DPI will review each modification request and contact the individual listed in the contact information provided if any clarification is needed for the request. 

The following information in the Data Use Agreement are allowed for modifications.  Any modifications to the Data Use Agreement outside the parameters listed below will require a new Data Use Agreement Application to be created with DPI for processing.

  • DUA Change of Information Request - a request for "non-substantive changes"* to an existing Data Use Agreement.
  • DUA Renewal Request -  a request to renew an existing Data Use Agreement under the same terms and conditions as the original request except for the effective dates of the agreement plus any "non-substantive changes"*.  
    Example:  A DUA was written for 2 years in duration and is expiring.  The DUA Renewal Request is written to renew the DUA for another 2 years with refreshed data and the same terms and conditions. 
  • DUA Extension Request - a request to extend an existing Data Use Agreement beyond the existing expiration date listed in the Data Use Agreement plus any "non-substantive changes"*.  
    Example:  A DUA was written for 2 years in duration and is expiring.  The DUA Extension Request is written to extend the DUA for one more month to complete the study.

* Non-substantive changes are required as part of the DUA agreement to keep the DUA current. The allowed DUA non-substantive changes are defined as a change in the option year, primary contact name, primary contact street address, primary contact email address, primary contact phone number, organization name, organization street address, additional data elements or data recipient(s).

NOTE !  Do not submit any Sensitive Personally Identifiable Information (SPII) through this form.  For a list of SPII examples click here.

Any phone number format will do, but include your area code like: 920-555-1212
Type of DUA Modification
Supporting information explaining the modification request. Do not enter any Sensitive Personally Identifiable Information (SPII) in this section.
Change DUA Start Date
Enter the new DUA start date.
Change DUA Expiration Date
Enter the new DUA Expiration date.
Change Data Destruction Date
Enter the requested date to modify the data destruction date.
Enter the first and last name of the individual(s) to add as data recipient(s).
Enter the first and last name of the individual(s) to remove as data recipient(s).
Enter the DPI Document Control Number for the DUA you want to modify. If you can not find a DPI Document Control Number, enter 'No number found".
Enter the title of the DUA you are modifying.
Enter the changes for organization name or address.
Enter any modifications to the primary contact name, email, address or phone.

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