Institutional Research and Assessment Request Form
Note: All questions are required

Type of request:
[Check one]
Institutional statistics TK20
Program-level statistics Peer data/benchmarking
Surveys Research study
Assessment Other, specify

Enrollment/employee categories to include:
[Check all that apply]
All students Full-time graduate
All undergraduate First-time full-time freshmen (cohort)
All graduate New full-time transfer cohort
All day undergraduate Full-time faculty
All adult undergraduate Adjunct faculty
Full-time day undergraduate Other, specify
Full-time adult undergraduate N/A

[Check all that apply]
All campus locations Pottsville
Main Other, specify
Philadelphia N/A

Time range:
[Check all that apply]
Current year fall (Oct 15) Last 5 years (Oct 15)
Current year spring (Mar 15) Others, specify
Last 3 years (Oct 15) N/A

Identify additional selection criteria:
[Describe in detail]

Primary purpose of request:
Accreditation Program development Internal reporting
Assessment Planning Grant application
Program review External reporting Other, specify

Department requesting :
If other, specify
Contact e-mail
Contact name

Date submitted (mm/dd/yyyy)
Date needed (mm/dd/yyyy)
Please allow two weeks after submission.

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