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

Survey Details

How will the information be used, what question(s) are you trying to answer, what populations are most relevant to your question(s)?

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

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

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

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

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

Share any other information with the IUPUI Survey Committee.

Survey Population Information

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

Graduate Students
Non-Degree Students
Auditing Students

Note: Please provide specific details for your response "Other" in the Population Details section below.

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?

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.

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).

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

Data Use and Stewardship

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

Program Review
Campus Improvement
Departmental Improvement
Personal Research
Institutional Research
Regional/National Survey

Describe in a few words any other purposes for the survey data.

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).

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

Excellence in Advancement
Building for Excellence
The Centrality of Information
Responsible Stewardship

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

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

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.

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

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

Share key findings from the most recent administration and any impacts of the previous administration

Compliance with IRB

The IUPUI 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

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.

Please attach the survey instrument if available.

Please attach other files if necessary.