Data Report and Survey Request Form

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* 1. What is your name?

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* 2. What is your email address?

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* 3. Are you faculty or staff?

Faculty

Staff

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* 4. Please describe the purpose of the data report or survey.

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* 5. What type(s) of data do you need? Select all that apply.

Student Enrollment

Course Completion Rates

Graduation Rates

Faculty Information

Staff Information

Financial Data

Other

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* 6. What is the intended use of the requested data?

Academic Research

Departmental Review

Strategic Planning

Grant Application

Other

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* 7. If you selected 'Other' in any of the above, please specify.

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* 8. Please provide any additional details or specific questions you have regarding the data.

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* 9. When would you need the request completed?

Date / Time

Date

Time

AM/PM