<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><html lang="en-US"><head><script language="JavaScript" type="text/javascript">function keepAlive(){var i=new Image();var d=new Date();i.src="siam/surveylanding/alive.asp?sid=746D70666B666E646C313336393239323231332E3138&d="+d.valueOf();}setInterval("keepAlive()",1800000);</script><meta name="GENERATOR" content="snap10 - pda3 questionnaire export"><meta http-equiv="Content-Type" content="text/html; charset=utf-8"><meta name="HandheldFriendly" content="true"><meta name="viewport" content="width=device-width, minimum-scale=0.25, initial-scale=1.0, maximum-scale=4.0"><title>Data Request Form</title><style type='text/css'><!--th{font-weight:normal;}select{font-size:100%;}hr{margin:0px;}.w3label{width:0px;height:0px;line-height:0px;overflow:hidden;position:absolute;top:-1000px;}--></style><script language='javascript' type='text/javascript'>document.write("<style 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summary="" id="V2"><tr><td bgcolor='#FFFFFF' align="center" valign="top" width="100%" style="padding:1px 0px;"><font size="+2" face="Arial"><b><font color="#1B5BAB">Office of Institutional Research and Analysis<br>DATA REQUEST FORM</font><br><img src="http://snapsurvey.moreheadstate.edu/snapwebhost/k/135904797329/oira-logo_gif.gif" alt="" width='126' height='89' >&nbsp;</b></font></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V3_SPACER"><tr><td height="18"></td></tr></table><table style="border:solid #000000 2px;" border="0" cellpadding="0" cellspacing="0" width="100%" class='V3_classT' summary="" id="V3"><tr><td bgcolor='#1B5BAB' align="left" valign="top" width="100%" style="padding:1px 0px;"><font color='#F9E035' face="Arial"><b>Upon receipt of your data request, if needed, an O.I.R.A. representative will contact you to verify your request and discuss project details and timelines.</b></font></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V4_SPACER"><tr><td colspan="2" height="18"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" class='V4_classT' summary="" id="V4"><tr><td align="left" valign="top" rowspan="2" width="8%" height="100%" style="padding:1px 0px;"><font size="+1" face="Arial"><b><span class='qnum'><a name="Q1">1.</a></span></b></font></td><td align="left" valign="top" width="92%" style="padding:1px 0px 5px;"><font size="-1" face="Arial"><b><label for="V4_1">The person making the data request is a/an:</label></b></font></td></tr><tr><td align="left" valign="top" width="92%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><select name="V4" id="V4_1" style="color:#000000;;"><option value="">--Click Here--</option><option value="1">MSU Dean</option><option value="2">MSU Department Chair</option><option value="3">MSU Vice President</option><option value="4">MSU Assistant/Associate Vice President</option><option value="5">MSU Director</option><option value="6">External Constituent</option></select></i></font></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V7_SPACER"><tr><td height="18"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" class='V7_classT' summary="" id="V7"><tr><td bgcolor='#1B5BAB' align="center" valign="top" width="100%" style="padding:1px 0px;"><font size="+1" color='#F9E035' face="Arial"><b>Contact Information for Person Submitting Request to OIRA:</b></font></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V37_GRID"><tr class='V37_classR'><td align="left" valign="top" width="8%"><span class='qnum'><a name="Q1.a">&nbsp;</a></span></td><th scope="row" align="right" valign="bottom" width="34%" style="padding:1px 1px 1px 0px;"><font size="-1" face="Arial"><label for="V37_1">Name :</label></font></th><td align="left" valign="bottom" width="50%" height="2"><input type="text" size="25" maxlength="9999" id="V37_1" style="width:74%;" name="V37"></td><td width="8%">&nbsp;</td></tr><tr class='V45_classR'><td align="left" valign="top" width="8%" height="100%"><font size="+1" face="Arial"><b>&nbsp;</b></font></td><th scope="row" align="right" valign="bottom" width="34%" style="padding:1px 1px 1px 0px;"><font size="-1" face="Arial"><label for="V45_1">Phone Number (xxx<font size=-1 color="#B22222">-</font>xxx<b><font size=-1 color="#B22222">-</b></font>xxxx):</label></font></th><td align="left" valign="bottom" width="50%" height="2"><input type="text" size="15" maxlength="15" id="V45_1" style="width:45%;" name="V45"></td><td width="8%">&nbsp;</td></tr><tr class='V38_classR'><td align="left" valign="top" width="8%" height="100%"><font size="+1" face="Arial"><b>&nbsp;</b></font></td><th scope="row" align="right" valign="bottom" width="34%" style="padding:1px 1px 1px 0px;"><font size="-1" face="Arial"><label for="V38_1">Email Address :</label></font></th><td align="left" valign="bottom" width="50%" height="2"><input type="text" size="15" maxlength="9999" id="V38_1" style="width:45%;" name="V38"></td><td width="8%">&nbsp;</td></tr><tr class='V39_classR'><td align="left" valign="top" width="8%" height="100%"><font size="+1" face="Arial"><b>&nbsp;</b></font></td><th scope="row" align="right" valign="bottom" width="34%" style="padding:1px 1px 1px 0px;"><font size="-1" face="Arial"><label for="V39_1">College/Unit/Division/Company or Organization:</label></font></th><td align="left" valign="bottom" width="50%" height="2"><input type="text" size="15" maxlength="9999" id="V39_1" style="width:45%;" name="V39"></td><td width="8%">&nbsp;</td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V44_SPACER"><tr><td height="18"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" class='V44_classT' summary="" id="V44"><tr><td bgcolor='#1B5BAB' align="center" valign="top" width="100%" style="padding:1px 0px;"><font size="+1" color='#F9E035' face="Arial"><b>Details Regarding Requested Data</b></font></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V56_SPACER"><tr><td colspan="2" height="18"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" class='V56_classT' summary="" id="V56"><tr><td align="left" valign="top" rowspan="2" width="8%" height="100%" style="padding:1px 0px;"><font size="+1" face="Arial"><b><span class='qnum'><a name="Q2">2.</a></span></b></font></td><td align="left" valign="top" width="92%" style="padding:1px 0px;"><font size="-1" face="Arial"><b><label for="V56_1">If data is needed by a specific date, please indicate the due date by choosing the appropriate calendar day using the icon below. &nbsp;Otherwise, you request will be completed in the order it was received.<br><i><font color="#B22222">NOTE: &nbsp;Please allow a minimum of three business days when choosing a due date:</i></font></label></b></font></td></tr><tr><td align="left" valign="bottom" width="92%" height="2"><input type="text" size="1" maxlength="100" class="dateInput$64_snerin3_data_request_form_calendarxlarge2222b2" id="V56_1" style="width:2%;" name="V56"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V28_SPACER"><tr><td colspan="2" height="18"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" class='V28_classT' summary="" id="V28"><tr><td align="left" valign="top" rowspan="2" width="8%" height="100%" style="padding:1px 0px;"><font size="+1" face="Arial"><b><span class='qnum'><a name="Q3">3.</a></span></b></font></td><td align="left" valign="top" width="92%" style="padding:1px 0px;"><font size="-1" face="Arial"><b><label for="V28_1">Describe your data request. Be as specific and detailed as possible. &nbsp;(e.g., What is/are the question(s) you are trying to answer?) &nbsp;</label></b></font></td></tr><tr><td align="left" valign="bottom" width="92%" height="2"><textarea rows="3" cols="62" id="V28_1" style="width:100%;" name="V28"></textarea></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V40_SPACER"><tr><td colspan="2" height="18"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" class='V40_classT' summary="" id="V40"><tr><td align="left" valign="top" rowspan="2" width="8%" height="100%" style="padding:1px 0px;"><font size="+1" face="Arial"><b><span class='qnum'><a name="Q4">4.</a></span></b></font></td><td align="left" valign="top" width="92%" style="padding:1px 0px;"><font size="-1" face="Arial"><b><label for="V40_1">Please indicate the term for which you are requesting data (i.e., fall 2012, last three academic years):</label></b></font></td></tr><tr><td align="left" valign="bottom" width="92%" height="2"><input type="text" size="33" maxlength="9999" id="V40_1" style="width:53%;" name="V40"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V53_SPACER"><tr><td colspan="6" height="18"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" class='V53_classT' summary="" id="V53"><tr><td align="left" valign="top" rowspan="2" width="8%" height="100%" style="padding:1px 0px;"><font size="+1" face="Arial"><b><span class='qnum'><a name="Q5">5.</a></span></b></font></td><td align="left" valign="top" colspan="5" width="92%" style="padding:1px 0px 5px;"><font size="-1" face="Arial"><b>The information for which we will provide data should be based upon: &nbsp;(choose all that apply)</b></font></td></tr><tr><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="1" id="V53_1" name="V53"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V53_1">Student Information</label></i></font></td></tr></table></td><td width="4%">&nbsp;</td><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="2" id="V53_2" name="V53"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V53_2">Faculty Information</label></i></font></td></tr></table></td><td width="4%">&nbsp;</td><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="3" id="V53_3" name="V53"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V53_3">Staff Information</label></i></font></td></tr></table></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V42_SPACER"><tr><td colspan="6" height="18"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" class='V42_classT' summary="" id="V42"><tr><td align="left" valign="top" rowspan="4" width="8%" height="100%" style="padding:1px 0px;"><font size="+1" face="Arial"><b><span class='qnum'><a name="Q6">6.</a></span></b></font></td><td align="left" valign="top" colspan="5" width="92%" style="padding:1px 0px 5px;"><font size="-1" face="Arial"><b>Please indicate which student fields you want included in your dataset (choose all that apply):</b></font></td></tr><tr><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="1" id="V42_1" name="V42"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V42_1">Academic Level (UG, GR, etc.)</label></i></font></td></tr></table></td><td width="4%">&nbsp;</td><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="2" id="V42_2" name="V42"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V42_2">Classification (Freshman, Sophomore, etc.)</label></i></font></td></tr></table></td><td width="4%">&nbsp;</td><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="3" id="V42_3" name="V42"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V42_3">Enrollment Status (Full-time or Part-TIme)</label></i></font></td></tr></table></td></tr><tr><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="4" id="V42_4" name="V42"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V42_4">Ethnicity/Race</label></i></font></td></tr></table></td><td width="4%">&nbsp;</td><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="5" id="V42_5" name="V42"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V42_5">Name (First Name, Last Name)</label></i></font></td></tr></table></td><td width="4%">&nbsp;</td><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="6" id="V42_6" name="V42"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V42_6">Gender</label></i></font></td></tr></table></td></tr><tr><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="7" id="V42_7" name="V42"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V42_7">MSU ID</label></i></font></td></tr></table></td><td width="4%">&nbsp;</td><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="8" id="V42_8" name="V42"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V42_8">Preferred Email Address</label></i></font></td></tr></table></td><td width="4%">&nbsp;</td><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="9" id="V42_9" name="V42"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V42_9">Term</label></i></font></td></tr></table></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V57_SPACER"><tr><td colspan="6" height="18"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" class='V57_classT' summary="" id="V57"><tr><td align="left" valign="top" rowspan="3" width="8%" height="100%" style="padding:1px 0px;"><font size="+1" face="Arial"><b><span class='qnum'><a name="Q7">7.</a></span></b></font></td><td align="left" valign="top" colspan="5" width="92%" style="padding:1px 0px 5px;"><font size="-1" face="Arial"><b>Please indicate which faculty/staff fields you want included in your dataset (choose all that apply):</b></font></td></tr><tr><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="1" id="V57_1" name="V57"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V57_1">Ethnicity/Race</label></i></font></td></tr></table></td><td width="4%">&nbsp;</td><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="3" id="V57_3" name="V57"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V57_3">MSU ID</label></i></font></td></tr></table></td><td width="4%">&nbsp;</td><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="5" id="V57_5" name="V57"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V57_5">Preferred Email Address</label></i></font></td></tr></table></td></tr><tr><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="2" id="V57_2" name="V57"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V57_2">Gender</label></i></font></td></tr></table></td><td width="4%">&nbsp;</td><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="4" id="V57_4" name="V57"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V57_4">Name (First Name, Last Name)</label></i></font></td></tr></table></td><td width="4%">&nbsp;</td><td align="left" valign="top" width="28%" height="100%"><table border="0" cellpadding="0" cellspacing="0" height="100%" width="100%" summary=""><tr><td align="left" valign="top" width="7%" height="2"><input type="checkbox" value="6" id="V57_6" name="V57"></td><td align="left" valign="middle" width="93%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><label for="V57_6">Term</label></i></font></td></tr></table></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V46_SPACER"><tr><td colspan="2" height="18"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" class='V46_classT' summary="" id="V46"><tr><td align="left" valign="top" rowspan="2" width="8%" height="100%" style="padding:1px 0px;"><font size="+1" face="Arial"><b><span class='qnum'><a name="Q8">8.</a></span></b></font></td><td align="left" valign="top" width="92%" style="padding:1px 0px;"><font size="-1" face="Arial"><b><label for="V46_1">Please list any other fields not listed above that you would like provided in your completed dataset (please separate each field with a ',' or other indicator):</label></b></font></td></tr><tr><td align="left" valign="bottom" width="92%" height="2"><input type="text" size="60" maxlength="9999" id="V46_1" style="width:96%;" name="V46"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V51_SPACER"><tr><td colspan="2" height="18"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" class='V51_classT' summary="" id="V51"><tr><td align="left" valign="top" rowspan="2" width="8%" height="100%" style="padding:1px 0px;"><font size="+1" face="Arial"><b><span class='qnum'><a name="Q9">9.</a></span></b></font></td><td align="left" valign="top" width="92%" style="padding:1px 0px 5px;"><font size="-1" face="Arial"><b><label for="V51_1">Please indicate how the information will be used:</label></b></font></td></tr><tr><td align="left" valign="top" width="92%" style="padding:1px 1px 1px 5px;"><font size="-1" face="Arial"><i><select name="V51" id="V51_1" style="color:#000000;;"><option value="">--Click Here--</option><option value="1">Departmental Data Needs</option><option value="2">Determining Honor Society Nominees</option><option value="3">Determining Recipients of Student Awards</option><option value="4">External Reporting Purposes</option><option value="5">Internal Decision Making</option><option value="6">Internal Reporting of Drop/Adds or Failing Students</option><option value="7">Notification of Program Requirement Changes/Deadlines</option><option value="8">Procurement of Price Reductions for Institutional Software/Services</option><option value="9">Programmatic Review/Accreditation</option><option value="10">Report/Presentation</option><option value="11">Other: &nbsp;Please explain in the space provided below this question</option></select></i></font></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V52_SPACER"><tr><td colspan="2" height="18"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" class='V52_classT' summary="" id="V52"><tr><td align="left" valign="top" rowspan="2" width="8%" height="100%" style="padding:1px 0px;"><font size="+1" face="Arial"><b><span class='qnum'><a name="Q10">10.</a></span></b></font></td><td align="left" valign="top" width="92%" style="padding:1px 0px;"><font size="-1" face="Arial"><b><label for="V52_1">Other explanation of how information will be used:</label></b></font></td></tr><tr><td align="left" valign="bottom" width="92%" height="2"><input type="text" size="61" maxlength="9999" id="V52_1" style="width:98%;" name="V52"></td></tr></table><table border="0" cellpadding="0" cellspacing="0" width="100%" summary="" id="V29_SPACER"><tr><td height="18"></td></tr></table><table style="border-color:#F9E035;border-width:6px 0px;border-style:solid none;" border="0" cellpadding="0" cellspacing="0" width="100%" class='V29_classT' summary="" id="V29"><tr><td bgcolor='#FFFFFF' align="center" valign="top" width="100%" style="padding:1px 0px;"><font color='#1B5BAB' face="Franklin Gothic Medium"><b><i><font face="Arial">All data requests are prioritized as they are received in the Office of Institutional Research and Analysis.<br>An O.I.R.A. representative will contact you as soon as possible regarding your request.<br></font><font face="Arial" size=+1><br></i></font><font face="Arial" size=+1 color="#B22222">If you have additional files (Word, Excel, etc.) that you would like to send OIRA at this time, please click on the following link to open our email address:<br><i></font><font face="Arial"><a href = 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