Date: |
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Department: |
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Requestor: |
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Supervisor: |
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Email: |
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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 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? |
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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? |
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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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