Institutional Effectiveness Data Request Form 1. Contact Information Please Note: Use this online form only to request data from UC Clermont Institutional Effectiveness. The time from request to delivery depends on the complexity of the request and availability of staff. Please provide as much advanced notice as possible if you are working with a deadline. Question Title * Name Question Title * Email Question Title * Phone Question Title * Status: UC Clermont Administrator UC Clermont Faculty UC Clermont Staff UC Clermont Student UC Administrator/Faculty/Staff/Student Community Other (please specify) Question Title * Type of request (check all that apply) Data or Report Request Data Analysis and Research Research Consultation Other (please specify) Question Title * Type of data requested (check all that apply) Academic & Program Data Degrees Awarded Enrollment (student, course, program) Employee (faculty, staff) Financial Aid Labor Market Analysis (JobsEQ, Gray's PES) Persistence/Retention Survey Other (please specify) Question Title * Describe the request (include specific data elements you need included) Question Title * Upload related files, if necessary DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Upload related files, if necessary Question Title * Please specify the year(s)/semester(s) requested (current semester, Fall 2017, Academic Year 2016-17, etc.) Question Title * Purpose of request (How will it be used? Who is the intended audience?) [check all that apply] Accreditation Academic/Co-Curriculuar Assessment External Survey/Report Grant Application or Support Key Performance Indicator Measurement New Program Development Program Review/Evaluation (academic, discipline, co-curricular programs/services) Survey Other (please specify) Question Title * These data will be used for (check all that apply) Internal campus/departmental need Reporting for UC External (non-UC reporting) Other (please specify) Question Title * Date needed by (most requests should be made at least one week in advance of the date needed): Date / Time Date Question Title * Is this a recurring/cyclical request (Do you need these data every semester, annually, etc.)? Yes No Question Title * If yes, how often/when do you need the report? Question Title * I confirm I have reviewed the FERPA reference sheet (for faculty at http://www.uc.edu/content/dam/uc/registrar/docs/FERPA/FERPA_for_faculty.pdf) (for staff at http://www.uc.edu/content/dam/uc/registrar/docs/FERPA/FERPA_for_office_personnel.pdf) Yes Question Title * I confirm I have reviewed the UC Data Governance & Classification Policy 9.1.1.A Data Classification and Data Types at http://www.uc.edu/content/dam/uc/infosec/docs/policies/Data_Governance_and_Classification_Policy_9.1.1.A.pdf and will apply the appropriate reasonable level of security to protect these data. Yes Done