The following form should be completed if you are collecting student, alumni, faculty, and/or staff feedback through surveys, focus groups, interviews, etc. If you require assistance in completing the form or are unsure as to whether your assessment activity necessitates review, contact OIRA.

Project title:

 
     

Contact Information:
  First Name
  MI
  Last Name
     
  Unit/Department
 
     
  Campus Address
 
     
  Campus Phone
 
     
  Email  
 
     
  Sponsoring Department(s)/Office(s)
 
     
     
1. Purpose and importance of this study:
 
     
2. Target population for data collection:
 
     
3. Proposed timeframe for this study:
 
     
   
4. Intended methodology: (check all that apply)
 
online survey student records analysis
paper survey document analysis
focus group other (specify)
interview unsure; would like to discuss
   
5. Means by which participants will be selected:
 
   
6. This study is expected to be:
  a one-time project
  a recurring project
   
  If this study is expected to be a recurring project, specify how often: 
 
   
7. Have you submitted a proposal to the Institutional Review Board?
  Yes     No     Not required
   
  If yes, have you received IRB approval at this time?
  Yes     No 
   
8. Has this study been previously conducted?
  Yes     No
     
 

If yes:

  Provide the date of previous administration(s).
 

     
  Describe the rationale for repeating the study.
 
     
  Explain how the previously collected data were used.
 
     
9. Describe any incentives that will be offered to participants (if applicable).
 
     
10. Describe how the results of this study will be used.
 
     
11. Are you requesting assistance from OIRA? Yes No
   
  If yes, indicate which area(s): (check all that apply)
 
Planning Analysis and interpretation
Instrument development Reporting
Data collection Unsure; would like to discuss
Data processing/programming    
   
   
  Please click here to email OIRA a a copy of the survey instrument or focus group/interview protocol.