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Request to Conduct Survey at Pellissippi State

Faculty and staff at the College who wish to conduct a survey at Pellissippi State using any members of the Pellissippi State population must submit this form. Your survey procedure must be approved by the Institutional Research office before your survey is administered.

Information collected from this online form will also be used to compile the College's Survey Archive that is published on this Web Site. After submitting this form, please forward a copy of the instrument that will be used for the survey to the Office of Institutional Effectiveness, Research, and Planning by e-mail or campus mail.

Thank you.

Items marked with an asterisk (*) are required.

Contact Name and/or Survey Originator*:
Title*:
Department/Unit:
E-Mail Address*:
Phone Number:

IDENTIFY THE GOAL OR GOALS RELATED TO THIS REQUEST:

Please identify the goal or goals related to this request. Goals can be viewed on the Institutional Research web site under College Initiatives.

Performance Funding

 General Education Goals
 Strategic Planning

Date you wish to conduct survey:
Reference, if applicable, for goal(s) not listed above:
Reference, if applicable, departmental goal(s) not listed above:
Reference, if applicable, performance review goal(s) not listed above:
Population you wish to survey:
Describe how the results of this survey were or will be used:

4. Submit Your Request:

Thank you for your request. You will be notified when your request is approved. Please call if you have further questions.

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Updated: 10-30-09 (SML)
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Knoxville, Tennessee 37933-0990 - Email: jhheuer@pstcc.edu - Phone: 865-694-6526