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.

IRDS Survey Approval Form

Contact Information
Name Name * First Last
Department *
Phone Phone * - ### - ### ####
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)?
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 Start Date * / MM / DD YYYY
Preferred End Date Preferred End Date * / MM / DD YYYY
Alternate Start Date Alternate Start Date * / MM / DD YYYY
Alternate End Date Alternate End Date * / MM / DD YYYY
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 IUPUI Survey Committee.
Survey Population Information
Target Population *

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

Indicate which populations you wish to survey (select all that apply).
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
Do you need the IUPUI Survey Committee to provide you a sample? *

Do you need the IUPUI Survey Committee to provide you a sample? Yes, we would like the IUPUI Survey Committe to provide a sample. No, we will be providing our own sample.

Note: Please provide specific details for your sample in the Indicate Sample Size section below.
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 IUPUI 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 *

Data Use Accreditation Program Review Assessment Campus Improvement Departmental Improvement Personal Research Institutional Research Regional/National Survey Other Other

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

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

https://strategicplan.iupui.edu/Strategic-Initiatives
The Principles of Excellence

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

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 *

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

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 here.
FERPA Compliance

IU's FERPA Tutorial: https://ferpa.iu.edu/index.html
FERPA Guidance: https://research.iu.edu/compliance/human-subjects/guidance/ferpa.html
FERPA Compliance *

FERPA Compliance 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.

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

1. meet the agreed upon criteria for inclusion in the sample population
2. are at least 18 years old, and
3. 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 sample design restrictions and acknowledge that updates to the sample cannot be made after it is compiled and delivered. *

I understand the sample design restrictions and acknowledge that updates to the sample cannot be made after it is compiled and delivered. Confirm
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 IUPUI *

This Survey has been administered previously at IUPUI Yes No
Approximate Date of Last Administration
Previous Findings

Share key findings from the most recent administration and any impacts of the previous administration
Compliance with IRB
Current Stage in the IRB Approval Process *

Current Stage in the IRB Approval Process 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

The IUPUI Survey Committee is not responsible for ensuring compliance with IRB requirements.
IRB Application Number
IRB Approval Date IRB Approval Date / MM / DD YYYY
IRB Approval Notice

Attach Files

Please attach the official IRB approval letter if available.
Survey Documents
For final approval of the survey, the IUPUI Survey Committee 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

Attach Files

Please attach the survey instrument if available.
Additional Files

Attach Files

Please attach other files if necessary.

Survey Approval Form

IRDS Survey Approval Form

Contact Information

Survey Details

Survey Population Information

Survey Sample Information

Data Use and Stewardship

Strategic Plan

FERPA Compliance

Sample Design

Administration Cycle and History

Compliance with IRB

Survey Documents

For final approval of the survey, the IUPUI Survey Committee 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.