Santa Rosa Junior College OFFICE OF INSTITUTIONAL RESEARCH

RESEARCH REQUEST FORM

Please complete the following information. Should you have any questions or need consultation, please call the Office of Institutional Research. You may also request this form as a word document, or write out the answers to the questions on a separate page.

Note: All requests require the signature of the Supervising Dean or Director, and the Component Administrator. Requests are prioritized by the Institutional Research Advisory Group in consultation with the Office of Institutional Research.

1. Contact and General Information:

Date of request:

 

Date information needed:

 

Contact Person:

 

Department/Division:

 

Extension:

 

e-mail address:

 

 

2. Project Title:

 

 

3. The information is needed to fulfill the following type of project:

□ State/Federal Mandate

□ Program Review

□ Institutional Planning/Master Plan

□ Accreditation

□ Grant Proposal

□ Campus or Departmental Project

□ Individual Faculty/Staff Project

□ Other:___________________________________

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

 

 

 

 

 

 

 

 

5. In what format would you like the information? (Please provide a "mock-up" if possible)

□ Report (including narrative interpretation, graphics, etc.) Please note that if you choose this option it will require consultation and editing time; this needs to be factored into the timing of your request.

□ Hard copy table of the results

□ Hard copy graphics of the results

□ Excel file (you will do your own statistical analysis)

□ Other (please explain):

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

 

 

 

 

 

 

7. Please describe your request in detail, including the scope, specific variables and time frames, etc.

 

 

 

 

 

 

 

 

 

  1. How will this information impact current practice?

 

 

 

 

 

9. Will the project become a recurring one? □ Yes □ No

If yes, how often and when does it need to be scheduled?

 

10. Does this project have a fiscal impact? □ Yes (If yes, please explain). □ No

 

11. To whom do you intend to distribute the information from your request?

 

 

 

12. Signature of Supervising Dean/Director:_____________________________________________________

Assessment of priority of project (check one): □ Critical □ High □ Medium □ Low

 

13. Signature of Component Administrator:______________________________________________________

Assessment of priority of project (check one): □ Critical □ High □ Medium □ Low

 

For Research Advisory Committee/Research Office Use Only

Date Received:_____________________________

Estimated Research Hours:___________________ Estimated Computing Services Hours:_________________

Disposition:________________________________ Date entered into project management:________________

OIR Project #:______________________________ Staff Assigned:___________________________________

Notes: