Department Data Request Form

Name:

 *

Name:

Department:

 *

Department:

Phone #:

 *

Phone #:

Email:

 *

Email:

Request Description (What type of data? For what group? Examples: ECC demographics, admit to enroll date, graduation rates & demographics, enrollment data, credit vs non-credit, etc.):

 *

Request Description (What type of data? For what group? Examples: ECC demographics, admit to enroll date, graduation rates & demographics, enrollment data, credit vs non-credit, etc.):

Purpose of the Request (who is the intended audience? How will the data be utilized?):

 *

Purpose of the Request (who is the intended audience? How will the data be utilized?):

Year(s) for which data is being requested:

Year(s) for which data is being requested:

Term(s) for which data is being requested:

Term(s) for which data is being requested:

Summer

Fall

Winter

Spring

Academic Year

Desired Output (e.g. aggregated or unit level, figures/tables or raw data):

 *

Desired Output (e.g. aggregated or unit level, figures/tables or raw data):

The purpose of this request is for: 

The purpose of this request is for:

Accreditation	Strategic Plan	Master Plan
Departmental Plan	Public Information Request	Grant Request
Grant Outcomes Assessment	Marketing Campaign	Other (provide brief reason for request) If other, type text here.

Please provide any additional information about the request:

Please provide any additional information about the request:

Please include any attachments that may be helpful (e.g. the report or table being populated):     

Please include any attachments that may be helpful (e.g. the report or table being populated): Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Date needed by:

Date needed by:

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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