Yavapai College : Survey Request Form

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

IR Online Survey Request