Name: Phone/Ext: Date:
Department/Office: Date results are needed:
Please indicate the type of service(s) you are requesting: Data for report Data for grant
Data for publicity Survey design
Other: Specify
Status: Administrator Staff
Faculty Other:
Select the term for which the data is requested and indicate the needed year:
Spring Summer
Fall Academic Year -
Fiscal Year -
Information requested:
How will requested data be used and of what benefit is it to the college/department/you?
Who will have access to this information?
Institutional Research & Assessment Office Use Only
Date Received in IR: Date Completed:
Request Completed By:
Submit Request to:
BPCC Institutional Research & Assessment
Building A Room 115
Fax: (318)678-6401
E-Mail: jyoung@bpcc.edu
Please complete this form completely so your request can be addressed in a timely manner. Turn-
around time on requests is dependent on work load in the office, but is generally not longer than 3-5
business days for data and 1-3 weeks for surveys.
Bossier Parish Community College
Office of Institutional Research and Assessment
Data/Survey Request Form
