Internal Research and Program Evaluation Request Form
Customer Name
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Email Address
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Phone Number
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CCS Department
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Job Title
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If you are completing this form on behalf of someone else, what is their name?
Select the service you are requesting.
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Survey: ask a group of individuals questions to gather information about what most people feel about a topic.
Poll: gather quick responses to a single question.
Event/Training/Professional Development Feedback: provide presenters or facilitators with information about how their audience felt about the content presented.
Data Analysis: gain insights from your data and/or combine it with another dataset.
Program Evaluation: evaluate the effectiveness and impact of a program, initiative, or strategy.
Consultation: discuss a research or evaluation project.
Not Sure
Other: may include but not limited to literature reviews, support in developing logic models and theories of change, needs assessments, focus groups, and interviews.
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