Submit a request – Department of Medicine IT Helpdesk

Please choose your issue below

Your email address

Subject(optional)

Type of Software

Select from drop down list

Will this Software be accessed from a Mac or a PC?

DOM ID Number

The 4-5 digit number on the device with a UW-Madison "W" logo. For example, DOM12345

Browser Requirement(optional)

List any special browser requirements, such as a particular browser extension

Software Name

Provide the name of the software tool

Software Vendor Name

Provide the name of the company that owns the software tool

Vendor URL

Provide the URL of the vendor and/or software tool

Who is the point of contact?(optional)

Provide the name and email address of the vendor's point of contact

What services will the vendor provide?(optional)

What services will the vendor provide?

Data Classification

UW Madison Data Classification - https://data.wisc.edu/data-governance/data-classification/

Specific business purpose

Provide detailed business case for use of the software. Examples, IRB Protocol Number, Clinical Trial information, Software bundled with research device (instrument, microscope, etc.)

Who will use the Software?

List who will use the software. Employee names, Human Subject participants, External Collaborators, etc.

What devices/endpoints will run/access the software?(optional)

Select from the drop down list

Does Campus offer similar tools or software?

Which campus software is similar and is there specific feature not provided by the campus software?(optional)

If No, what specific features are needed?(optional)

What is the price of this software?(optional)

Select from drop down list. If you have a quote attach it at the bottom of the form.

Do you have an external deadline and if so who set this deadline?(optional)

New software requests are reviewed every Tuesday and Thursday.

Provide a summary of your request

A member of our support staff will respond as soon as possible.

Attachments(optional)

Add file or drop files here