ASSESSMENT and INSTITUTIONAL RESEARCH
INTERNAL / EXTERNAL REQUEST FORM
Date of Request (MM/DD/YY format)
Name of Requestor
Organization or Department
Describe the request in detail (e.g., survey description, semesters desired, specific locations, etc.):
What is the institutional / instructional / educational purpose of this request?
Identify all individuals, by name and position (if not BPC employees, include affiliation and address) who will have access to the data you receive from us.
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 turnaround on all requests.