OFFICE OF INSTITUTIONAL RESEARCH
INTERNAL / EXTERNAL REQUEST FORM
Date of Request (MM/DD/YY format)
Name of Requestor
Department
Status
Faculty
Staff
Student
Other
Describe the request in detail (e.g., survey description, semesters desired, specific locations, etc.):
What is the institutional / instruction / education purpose of this request?
How will the information be used?
Will the information / research be published, and if so, where?
How will the confidentiality and security of the information be assured?
Please allow our office a two week time turn around for all requests.