Date:
Name:
Title:
Department:
Phone:
Email:

What is the focus of the survey?

         

          Who do you plan to survey?

              Students

              Faculty

              Staff

              Other  (Please specify)

            Will the survey be administered to the whole population or a sample?

              Population

              Sample

            If the survey is to be administered to a sample, what is the sample size and how will the

            sample be selected?

           How will the survey be administered?

              Mail

              Phone

              In-class

              Web

              E-mail

              Other  (Please specify)

            Does this research require approval from the Institutional Review Board? 

            ("You need to submit a research protocol to the IRB-Human Subjects for review and

            approval if you are doing any research that involves the use of human subjects.")

              Yes

              No

                        If it requires approval, has it been approved?

                        Yes

                        No

            When do you plan to begin administering the survey?  Enter mm/dd/yyyy.

            When will data collection be completed?  Enter mm/dd/yyyy.