Today's Date:                 Date Needed:    

Requested by: (List the name of Administrator, Department, Division, or Committee)

Contact Name:    E-Mail:

Project Title:       

1. Project Description: Please describe your request in detail, including the scope, specific variables and time frames, etc.

2. What questions do you want the data to answer?

3. What format would you like the information?
Report including narrative interpretation and graphics  (requires extra time for consultation and editing)
Hard copy table of the results
Hard copy graphics of the results
Excel file and you will do your own statistical analysis

4. How will this information impact current practice?

5. Please specify how the project supports applicable college plans (Master Plan, Institutional Goals, Unit Plans, divisional/departmental/program plans, etc.)

6. Will the project become recurring? Yes  How often and when? 
                                                       No        

PLEASE CHECK EACH OF THE FOLLOWING THAT APPLIES TO YOUR PROJECT:

13. Please explain how you intend to use the information. In other words, as a result of this activity what will you have gained?