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Please fill out all areas of the form. If you have a list that will be needed to process this request, such as Student ID, please email the list to jjmadden@actx.edu with the Request Title that will be used so the request and supporting information can be associated together.

1. * Request Type Data / Report Survey

2. Request Title*

3. Name of Requester*

4. Provide the project goals and/or research question you would like to answer. Please provide as much detail as possible.

5. Detailed Description / Instruction *

6. Does this project support a strategic goal of the college (please check below): Completion Align degrees and certificates with Labor Market Demand Learning Equity FInancial Effectiveness

7. Please describe how your request will meet the Strategic Plan. Please provide as much detail as possible.

8. Is this work aligned with a college committee’s work? If yes, please specify which one(s).

9. What is your tentative timeline? Please provide a specific date, or an estimate such as one month, two weeks, etc.

10. Is this research request college wide or campus specific? * College Wide Campus Specific

11. If campus specific, which ones? Washington St. East Campus West Campus Downtown Moore County Hereford

12. How will the results be used? Please be specific as possible.

13. If there are related documents to support this research request (e.g., List of ID's, meeting minutes, etc.), please email those documents to jjmadden@actx.edu.