Internal Data Request Form

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* Information:

Full Name:

Department:

Email Address:

Phone Number:

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* Type of Request:

Survey Form Development (Paper or Web)

Raw Data (Excel)

Survey Proctoring (Paper or Web)

Aggregated Data (Report)

Course Evaluation

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* Data Extraction Range

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* Purpose of Request (Goals, objectives, target audience, etc.)

***For Survey proctoring, please indicate the start and end date* *of proctoring.***

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* Provide us your Criteria Outline:

Data elements: enrollment status, location, gender, degree program, Native American, Dual Enrolled, Non‐degree seeking, etc. The more we know what you need, the more we can help you with your request.

Survey elements: questions, method of delivery, proctoring date, etc.

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* File Attachment

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* Needed By:

Date / Time

Date

Time

AM/PM

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***All Data Reports will undergo a Verification and Validated process prior to final submission by the Director of OIPR.***