Assessment Reporting Form

Please complete this form if you are involved in an assessment activity. If you are part of a group, ONLY ONE person should be designated to report the assessment on behalf of the entire group. Thank you.

First Name *

Last Name *

Role *

Other

Please enter the names of other faculty or staff that are contributing to your assessment (if not applicable, leave blank).

Position (select one) *

Faculty

Staff

Primary Dept. (select one) *

RIOS

CAMS

Access Services

Special Collections

Title of your assessment: (write in) *

Assessment Area (select all that apply) *

Information Literacy

Collections

Services

Other (Please enter in text below):

Assessment Area (Other)

Assessment Instrument (Select all that apply) *

Assessment Instrument (Other)

Indicate the number of participants (respondents, etc.) in the assessment (estimate if needed) *

Population (select all that apply) *

non-CSUN user applies to any off campus groups, such as Community, High School Students, etc.

Population (Other)

If you will be submitting data or a report, where do you intend to submit it? (select all that apply) *

Submitting data or a report (Other)

For whom are you making data or findings available? (Select one) -- Assessments for 'Personal use only' will not be listed on the assessment website. *

Personal use only

Internal use -- Library or Organization only

Public use

If you intend to present, publish or otherwise make publically available information obtained through your assessment using human subjects, have you consulted the Office of Research and Graduate Studies for instructions/approval? *

Yes

No

For more information, see: Office of Research and Graduate Studies

Is there any other information you feel would be helpful to us regarding your assessment?