Institutional Effectiveness Survey Request Form

Personal Information:

* Name

Prefix

Last Name

First Name

Suffix

Title: *

Department: *

Unit / College: *

Positions: *

Staff

Faculty

Faculty Advisor (student project)

Phone: *

Fax: *

Email Address: *

Confirm Email

Survey Information

Title of Survey: *

Purpose of Survey: *

Is survey sponsored (i.e., approved for distribution by supervisor and/or appropriate ASU administrators)? *

Yes

Survey Type & Use

Survey Type: *

In-house

University System of Georgia sponsored or mandated

National/Other large-scale survey with multiple institutional participating (examples: NSSE, BSSE, etc.)

External

This survey is a: *

New Survey

Old Survey (administered in the past)

How often should this survey be administered? *

When was the last administration? *

List semester, month, and year.

How will survey data/results be used internally? Mark all that apply. *

Needs Assessment

Program Accreditation

Internal Quality Assurance (examples: satisfaction survey, workshop/meeting evaluation, etc.)

Other (specify)

Not Applicable

Specify how the results
will be used internally:

How will survey data/results be used externally? Mark all that apply. *

Present at Conference

Program Accreditation

Research (dissertation, thesis, etc.)

Publication

Shared with community partner(s)

Other (specify)

Not Applicable

Specify how the results
will be used externally:

Survey Sample & Distribution

Who and how many will be surveyed? *

Be Specific. (Examples: faculty, staff, undergraduates by level, graduates by level, employers, alumni, community-at-large, etc.)

Survey Distribution: *

Online

Paper

Hybrid (online + paper)

If online, how?: *

Generic Link

Password Based Link per participant

QR Code

Email Addresses: *

Mark all that apply.

Do not have a list of email addresses

Have some email addresses

Have some email addresses, need missing addresses

Need University email distribution list

Custom email distribution list

Will survey question(s) ask for personal identifiable information (names, id numbers, email addresses, major, etc.)? *

Survey Start Date: *

Survey START date is: *

Flexible

Mandatory by a supervisor, chair, dean, committee, etc.

Mandated by an external entity

Survey Reminder Dates: *

Survey Close Date: *

Survey END date is: *

Flexible

Mandatory by a supervisor, chair, dean, committee, etc.

Mandated by an external entity

Is survey publicity needed beyond email communication? *

Yes

Please Specify: *

Describe incentives, if any, and include how incentives are sponsored.

Will you need raw survey data exported/extracted for additional analysis? *

Yes

Who will conduct additional analysis? *

I will do the analysis

Need Institutional Research assistance with analysis

Not Applicable

What format should raw data be prepared? *

Excel

Excel, CSV format

SPSS

Other (specify)

Not Applicable

Specify the format of the raw data: *

Explain how raw data will be secured to safeguard survey data and how long such data will be maintained. *

What is preferred software for the extraction? *

Examples: SPSS, Excel, Access, etc.

Explain: How will extracted data be data be securely stored? *

IRB Status: *

Pending

Approved

Not Required

Exempt/Public Domain

Approved

Not Required

Supporting Documents

Files are limited to 10 MB or less.

1) Proof of Survey sponsorship *

Document type PDF or DOCX

2) Survey Questions/Invitation or Flyer/Reminders/Thank You (in one Word document) *

Document type PDF or DOCX

3) IRB Application (approval) File upload

Document type PDF or DOCX

4) Copyright/Intellectual Property Status (approval) File upload

Document type PDF or DOCX