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* 1. What is your name?

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* 2. What is your email address? (Where should we send your data?)

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* 3. Are you requesting the data for yourself or someone else?

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* 4. What is your college status?

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* 5. CSCC Department/ External Organization Name

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* 6. Extension/Phone Number

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* 7. Purpose of the request

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* 8. Information needed. Be sure to include years or terms and population (e.g. degree seeking). For example: "I would like total enrollment for Fall 2023 by department."

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* 9. If you are asking for information to insert into a form or have a prior year example, please upload your file/form. This will help us get an idea of what you are requesting. IMPORTANT: If you are requesting data for research or other purpose that requires approval from the Institutional Review Board, please attach an approved IRB form here. Such requests will not be processed without an approved IRB document attached to the data request ticket.

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* 10. Date data is needed. Please allow at least 10 business days from current date and enter a specific date in the following format: mm/dd/yyyy

Date

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* 11. I understand that any data from Institutional Effectiveness/Institutional Research is provided with the understanding that the data will be used for only the purpose as stated in my request for data. Institutional Effectiveness/Institutional Research does not endorse and is not liable for the unauthorized usage or breach of confidentiality of data released pursuant to this request. Unauthorized usage or breach of confidentiality of requested data may result in disciplinary action.

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