Last updated on 5-11-2021 by Jonathan Buedts You must have JavaScript enabled to use this form. Name of the applicant * Position * Institution * Street and number * Postal code * City * Telephone number * E-mail address * Would like to use the 2018 Health Interview Survey data under the conditions described in the protocol agreement for the project below (one application per project): Name of the research project * Project coordinator: (if different from the applicant’s coordinates) Name Position Institution Street and number Postal code City Telephone number E-mail address Short description research project * Type of application * Access to an anonymous database Submit an application to the Information Security Committee Start date of project * Day12345678910111213141516171819202122232425262728293031 Day MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Year End date of the project * Day12345678910111213141516171819202122232425262728293031 Day MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Year Sources of the project funding * Your contact information is collected in accordance with the General Data Protection Regulation (EU) 2016/679 (GDPR) in order to contact you concerning your request. You have the right at any time to access, modify, delete or restrict the use of your data. To exercise these rights, you can contact Sabine Drieskens at sabine.drieskens@sciensano.be or Sciensano’s Data Protection Officer at dpo@sciensano.be or 02/642.51.02. If you have a complaint about the way your data are being processed, you can contact the Belgian Data Protection Authority: Drukpersstraat 35, 1000 Brussels – Tel: 02/274.48.00 – contact@apd-gba.be I give my consent to store my contact information in the context of my HIS 2018 data request. Consent contact information HIS * I give my consent to store my contact information for other purposes such as informing about updates of the HIS data or inviting to events organized by Sciensano. Consent contact information other Leave this field blank Submit
