Requestor Information

First and Last Name: *

Email Address:  *

Phone Number/Extension *

Division/Department/Program *

Role at Cerritos College: * Please Select One Faculty Manager/Administrator Classified Staff Student Not a Cerritos College employee or student

Have you obtained approval for this request from your Dean or Manager? *

  Yes
  No
  N/A (I am a dean or manager)

Description of Timeline

Select the reason that best describes the purpose of this request. Select all that apply *

  Annual Planning
  Grant application/evaluation
  Internal Discussion
  Marketing or outreach
  Presentation
  Program Review
  Program Accreditation
  State, Federal, or license reporting
  Other (fill in box)

Other reason for request

Does this request have a specific deadline (e.g., grant submission, presentation, etc.)? *

  Yes
  No

If yes, please provide the date:

If your request is needed before the 4 to 6-week lead time, please explain the urgency.
NOTE: Urgent requests will be considered on a case-by-case basis and may not be completed within the requested timeline.

If your project does NOT have a due date, your assigned analyst will work with you to determine the completion date based on the complexity of your request.

Data Request Details

Has IERPG provided similar data/reports to you in the past?*

  Yes
  No
  Not Sure

If yes, when was it last requested and which Research Analyst provided the information? Please included the project number if it was provided.

Date:

Research Analyst:
Project Number:

Describe your research request in detail.
Please include specific research question(s) that you wish to answer (e.g., How many students successfully completed xxxx course in xxxx term?). If you are seeking information about students, we need to know which students (e.g., First-Time at Cerritos College Student, students in a particular student group, etc.). Indicate the time range of the data requested (e.g., Last 4 primary terms, Fall 2021, etc.). Indicate the demographic variables you wish included and any aggregations/disaggregation needed (e.g., the number of math degrees awarded at Cerritos College each academic year from 2018 to present; disaggregated by gender). Please include all selection criteria. *

In order to best understand the request and organize the information accordingly, explain the purpose of your request and the intended audience. Please include how the data or research findings will inform your program goals, planning and/or influence the decision making for your department/program (e.g., grant proposal for evaluators, program evaluation to improve practices, presentation at department meeting or campus event, etc.). *

Request Format: * Please Select One Contact List (i.e., Excel file with requested contact information) Data File (i.e., Excel file with requested columns of data) Data Tables (i.e., pivot table) Presentation (i.e., PowerPoint) Report (i.e., PDF)

How often do you anticipate requesting this data?*

  This is a one-time request
  Repeating (e.g., annually, every semester, etc.)
  Other

Other:

Compliance and Acknowledgement of Understanding

By checking this box, I acknowledge that the data I am requesting from the IERPG Division may be denied, approved, cancelled, or prolonged.

 Yes, I acknowledge *

Data provided by IERPG must be used for Cerritos College purposes. Personal use of data are prohibited. The data that may be provided is to be used only for the purposes stated on the request form and approved by IERPG. Data provided may not be used for any other purposes or redistributed without prior written approval from the IERPG Division.

IERPG does not provide any raw data files to protect confidentiality and privacy, and to adhere to FERPA guidelines. Individuals/departments requesting data are expected to take measures to safeguard data. This includes securely storing data and safely disposing data. If provided data and/or a report by IERPG, do you agree that the data you are requesting will be:

1. used for college purposes only,
2. securely stored/safely disposed, and
3. guarded against unauthorized alteration or inappropriate usage in accordance with college policies, and federal and state laws

 Yes, I acknowledge *

Supplemental Documents: If you have supporting documents for your request (grant report requirements, unit planning documents, student list, etc.) please send an email to research@cerritos.edu with the attached documents.

If your supplemental documents include identifying student information, FERPA regulations require files be password protected anytime such information is shared via email. Passwords should be emailed separately from the files. While emailing FERPA-protected data is permissible under the law, the Department of Education has ruled that an institution will be held responsible for a violation if any unauthorized individual sees the protected data via your electronic transmission.

 Yes, I acknowledge *

Our timeframe for responding to data requests can vary depending on workload within our office. We strive to provide requestors a received email with a status of your request within 5 business days of receipt.

*Required Fields

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