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IUB Survey Approval Form

For full consideration, please review the Survey Approval Process and observe the following approval request form submission deadlines: July 1 for Fall semester surveys, November 1 for Spring semester surveys, and March 1 for Summer surveys.

Contact Information

Contact Person: Department: Telephone: Email:

Survey Details

Survey Name:
Purpose of the Survey:

How will the information be used, what question(s) are you trying to answer, what populations are most relevant to your question(s)? This description will used on the Official Surveys website.

Survey Keywords:

For use in the IUBSC Survey Data Repository and other projects. Please provide at least five keywords (e.g., student experience, information literacy). Press Enter to add the text you've typed as a keyword.

Proposed Format:

Online/web survey; paper and pencil survey; focus group; interview; etc.

Communications:

Please describe the type and number of communications that will be sent to individual respondents (e.g., email, postcards).

Survey Length:

How long do you expect the survey will take on average? Approximately how many questions will be asked?

Preferred Start Date:
Preferred End Date:
Alternate Start Date:
Alternate End Date:
Administration Date Constraints:

Explain your reasoning for the dates you prefer for this survey.

Incentives:

If participants will be compensated in any way, describe your plans for incentives.

Other Comments:

Share any other information with the University Survey Committee.

Survey Population Information

Target Population:

Indicate which populations you wish to survey (select all that apply).

Freshmen Sophomores Juniors Seniors Graduate Students
Staff Faculty Non-Degree Students Auditing Students Alumni Other
Population Details:

Please describe your population in detail, indicating any targeted populations (e.g., undergraduate women, students who identify as Hispanic or Latino/a, fraternity/sorority members).

Survey Sample Information

Sample:

Do you need the IUBSC to provide you a sample?

Yes, we would like the IUBSC to provide a sample. No, we will be providing our own sample.
Indicate Sample Size:

The total number of individuals you plan to invite to take your survey (e.g., census, 600 total individuals, 25% of the IUB undergraduate population).

Sample Details & Rationale:

Please indicate any special sampling instructions (e.g., stratified random sample) and explain why the desired sample is necessary.

Data Use and Stewardship

Data Use:

Indicate whether survey data will be used for any of the following purposes (select all that apply).

Accreditation Program Review Assessment Campus Improvement
Departmental Improvement Personal Research Institutional Research Regional/National Survey Other
Strategic Plan:

How does the survey support the strategic plan of Indiana University Bloomington? Please indicate how the survey supports at least one of The Principles of Excellence or The Framework of Excellence (select all that apply).

The Principles of Excellence

An Excellent Education An Excellent Faculty Excellence in Research The International Dimension of Excellence Excellence in the Health Sciences and Health Care Excellence in Engagement and Economic Development

The Framework of Excellence

Excellence in Advancement Building for Excellence The Centrality of Information Responsible Stewardship
Reporting Plans:

How will data be used and with whom will results be shared?

Data Stewardship

You assume all responsibility for ensuring that student, faculty and staff record data is never shared inappropriately. If you anticipate that record data or personal information about students, faculty or staff will be shared with any organization or individual not affiliated with Indiana University, Bloomington at any point as a result of this survey, indicate below.

Record Data will be shared with an organization or individual outside Indiana University, Bloomington
Record Data will NOT be shared with an organization or individual outside Indiana University, Bloomington

FERPA Compliance

You assume all responsibility for ensuring FERPA compliance. Please indicate your acknowledgement of this responsibility below.

I certify that all survey researchers have completed IU's FERPA Tutorial and familiarized themselves with FERPA Policies.
I understand that, if approved, the sample I am given will exclude individuals under 18 years of age and individuals who have filed a formal FERPA restriction to prevent sharing of their directory information.

Sample Design

Samples for campus-wide surveys are compiled based on your population criteria and the recommendation of the Indiana University Bloomington Survey Committee. Individuals will only be included in the sample if, at the time of sample creation, they

  • meet the agreed upon criteria for inclusion in the sample population
  • are at least 18 years old, and
  • have not filed a formal FERPA restriction to prevent sharing of their directory information

It is not possible to update the sample to reflect changes to eligibility after the sample is created (e.g., students who turn 18 after the sample is compiled will not be added to the sample).

I understand the above restrictions and acknowledge that updates to the sample cannot be made after it is compiled and delivered.

Administration Cycle and History

Administration Cycle:

How often will the survey be administered, e.g. annually, every semester, every two years, as needed.

This Survey has been administered previously at IU Bloomington

Compliance with IRB

The University Survey Committee is not responsible for ensuring compliance with IRB requirements. Please indicate your current stage in the IRB approval process below.

IRB approval is complete IRB approval is pending IRB approval is necessary but not yet submitted to IRB IRB approval is not required for this project

Survey Documents

For final approval of the survey, the IUBSC will require the survey instrument in order to ensure that the collected data do not duplicate existing data and that the survey is respectful of students, faculty and staff, and their time.

Survey Instrument:

Please attach the survey instrument if available.

Additional Files:

Please attach other files if necessary.

Submit Survey Approval Form