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Survey Request Form

If you would like Research, Evaluation, Assistance, and Planning to assist you with your survey, complete and submit a Survey Request Form. To ensure timely processing, a department head should submit this form. Thorough completion of the form will ensure the best possible outcome.

Complete the form as follows:

  • Download the form using the link provided below.
  • Open the form with Microsoft Word, check boxes as needed, and fill in all fields. Help for the fields are provided within the document. To get help on a field, click in the field and press F1.
  • Save the completed form and send a copy as an attachment along with any supporting documentation to

If you have any questions related to use or completion of this form, please contact Teri Kaasa,

Download Survey Request Form


Durham Technical Community College
1637 East Lawson Street
Durham, NC 27703

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