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Institutional Research Service Request Form
 Note: All questions are required
Type of information or service:
Institutional statistics Survey report/development
Program-level statistics Other, specify

Please identify the enrollment categories to be included in this request:
[Check all that apply]
Full-time day undergraduate
Part-time day undergraduate
Full-time continuous studies undergraduate
Part-time continuous studies undergraduate
Full-time graduate
Part-time graduate
Other, specify
Please identify additional selection criteria for this request:
[E.g. all juniors, all new Fall 2012 Transfer students, etc.]
Comments:
Please identify what this information or service will be used for:
Accreditation Planning Assessment
Program review External reporting Evaluation 
Grant application Internal reporting Other, specify

Timetable:
Institutional Research will respond to all requests within three weeks.
Date submitted (mm/dd/yyyy)
Date needed (mm/dd/yyyy)
 Person requesting information or service:
First Name
Last Name
Department
If other department, specify
E-mail
Phone number


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