The purpose of this form is to allow Institutional Effectiveness & Research to better understand the data/report you are requesting and the time frame in which you need a response. First Name: * Last Name: * Date: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20182019 Department/Sector: * Phone: * Email: * Request description: * Please provide a brief description of the request. Be sure to specify 1) the population or group of interest, 2) the period of time (e.g., Fall 2017 or Academic Year 16-17), and 3) the specific needed data elements. Request goal: * How will this research or information be used to improve student learning and success or advance college goals? Please check all that apply. Measure objectives or outcomes specified in the college’s Strategic Plan Complete required data for a grant accountability report Complete requirements for State, Federal, or President’s Office Complete instructional/student service program review (PR) or annual program update (APU) Complete requirements for institutional accreditation Evaluate a program Assess student learning (i.e. persistence, pass rate, graduation, transfer) Inform decision making for a division/department/program Establish goals and/or benchmarks for a division/department/program/class Inform/develop interventions or strategies for a division/department/program/class Provide data for a grant proposal Develop questions to explore based on the results Other: Request goal other: * Due date: * (Minimum of 10 business days) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year201820192020 FERPA regulations permit disclosure of personally identifiable information (PII) from students' education records to College officials with legitimate educational interests. A College official is a person employed by the College in an administrative, supervisory, academic, research or support staff position (including law enforcement unit personnel and health staff); a person serving on the board of trustees; or a student serving on an official committee, such as a disciplinary or grievance committee. A College official has a legitimate educational interest if the official needs to review education records in order to fulfill his or her professional responsibilities for the College. The Office of Institutional Effectiveness & Research reserves the right to share all reports generated with appropriate audiences. Please indicate your agreement to maintain the data provided to you in accordance with FERPA regulations. FERPA Agreement * I agree CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question * 15 + 4 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.