Internal Data Request Form Question Title * Information: (Required.) Full Name: Department: Email Address: Phone Number: Question Title * Type of Request: (Required.) Survey Form Development (Paper or Web) Raw Data (Excel) Survey Proctoring (Paper or Web) Aggregated Data (Report) Course Evaluation Question Title * Data Extraction Range (Required.) Question Title * Purpose of Request (Goals, objectives, target audience, etc.)For Survey proctoring, please indicate the start and end date of proctoring. (Required.) Question Title * 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. (Required.) Question Title * File Attachment Question Title * Needed By: (Required.) Date / Time Date Time AM/PM - AM PM Question Title ***All Data Reports will undergo a Verification and Validated process prior to final submission by the Director of OIPR.*** Submit
