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Request for Information Form

Information for Admission to the College

Conducting Research at Pellissippi State

The Request for Information Form has been designed to facilitate the management of data and to anticipate information needs. Persons within Pellissippi State seeking data or information about the College are requested to complete this online form in detail and to SUBMIT it to the Institutional Research office for processing.

Items marked with an asterisk (*) are required.

1. Contact Name and/or Name of Person Originating the Request

Name*:
Title*:
Department/Unit*:
E-Mail Address*:
Phone Number*:

2. Describe Your Request:

Information requested*:

How is this information to be used? :

Has Institutional Research provided this or similar information to you in the past?

Yes

If yes, please describe :

3. Connect Planning To Goals

Please identify the goal or goals related to this request. Select only the most pertinent goal(s). Follow the links to view each category in detail.

Performance Funding
Standards 1 A, B, C, D
Standard 2 A
Standards 3 A,B
Standards 4 A,B

General Education Goals
Goal 1
Goal 2
Goal 3
Goal 4
Goal 5
Goal 6
Goal 7

Strategic Planning
Goal 1
Goal 2
Goal 3
Goal 4
Goal 5

Department goal(s): Explain how request relates to goal(s) or standard(s) chosen above.
Individual goal(s): Explain how request relates to goal(s) or standard(s) chosen above.
Today's Date*:
Date Needed*:

4. Submit Your Request:

Thank you for your request.

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