| Date: |
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| Department: |
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| Requestor: |
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| Supervisor: |
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1. Briefly describe the survey being requested:
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2. When does the survey have to be administered? (Is this survey time-specific?)
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3. When are the analysis results needed? (Please be specific.)
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4. What level of analysis is needed?
Raw data only
Frequencies and descriptive data, no narrative
Frequencies and descriptive data w/narrative summary
Full study report w/data tables and narrative
Frequencies and descriptive data w/narrative summary
Other: |
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5. Will the survey audience include: (Mark all that apply)
Students
Faculty
Staff
Employers
Community Members
Other: |
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6. Approximate sample size or how many surveys will be distributed?
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7. Will the survey format be: (Mark all that apply)
Scannable
On-line
Focus Group
Telephone
Other: |
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8. Will the survey be administered: (Mark all that apply)
District-wide
Off-campus
Specific Campus/Center
Other
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9. Survey distribution method will be: (Mark all that apply)
Distributed in the classroom
Mailed
On-line
Telephone
Other |
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10A. How does the survey support the College's strategic plan?
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10B. How does the survey support your departmental plan?
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11. How will the survey results be used and what is the MEASURABLE outcome or benefit to the College?
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12. Is there a direct cost to administering the survey? (Noel Levitz, ACT, etc.)
No
Yes
If yes, please describe the costs. |
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