Your document uses formfield checkboxes, but lacks any text formfields for data entry so as to allow users to input the Requester Name, Requesting Dept., etc. details.

You should either replace the checkboxes with content control checkboxes, as Charles suggested, or add the necessary text formfields. Even if you replace the checkboxes with content control checkboxes, I'd recommend adding text content controls for data entry.

Which approach you take depends on who is to use the document. Formfields are supported in all Word versions. Content controls are only supported on PC versions of Word from 2007 on and on Mac versions of Word from 2013 on. Even on PCs, content control checkboxes only supported from Word from 2010 on. Content controls are also not supported in the doc format (which is what you're currently using).

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Cheers,
Paul Edstein
[Fmr MS MVP - Word]