Survey Request Form

Office of Integrated Institutional Effectiveness (OIIE)

Survey Request

PNWU Survey Request Process:
The process for scheduling a survey at PNWU follows. If you have any questions about this process, please contact OIIE staff.

Consult with OIIE to determine if there is data available or a planned survey available that will meet your survey needs. If not,
Develop the survey tool and define survey population
Obtain Institutional Review Board approval or exemption (if necessary--see PNWU Survey Policies and Procedures)
Submit the information requested in this Survey Request form to OIIE at least two weeks prior to the start date for the survey.
OIIE staff will review and respond to the Survey Request typically within one week

Requests for OIIE Assistance with Survey Development, Administration, and/or Reporting:

OIIE will consider requests for assistance with the development, deployment and analysis of surveys conducted by academic departments, committees and tasks forces, and administrative units as time permits. Assistance with external projects (e.g., grant-related projects conducted by PNWU faculty and staff may also be considered, but these will have a lower priority. Each request for OIIE assistance will be reviewed by the Provost and denied if OIIE office resources are not available.

Name*

First NameLast Name

Department*

Please indicate if you are:*

FacultyStaffStudentOther

Phone Number*

Area CodePhone Number

E-mail*

Describe the survey project

Please provide the purpose

Details regarding the specific population receiving the survey*

Please include the intended number of survey instrument recipients by people group type (# students, # faculty, # staff). Is it a sample of the population or the entire population of a people group type? If it is a sample, how will the sample be chosen?

Method of survey distribution (e.g. online or hard copy, via email, in class, at event, etc.)*

If the intent is for the survey to be delivered via the OIE Survey Monkey account please specify that here.

Please describe your plan to ensure the confidentiality of responses.*

How do you plan to explain the rights to survey respondents?*

Time frame for administering the survey, including beginning and end dates*

If the intention is for this survey to be a recurring survey, meaning it will be disseminated on a continuous basis (annually, biennially, every 5-years, etc.) please provide that information here.

Please describe the survey analysis plan (who will analyze the results, what will be analyzed, when will the analysis occur, and how will the results be analyzed)

If the intent is for OIE to assist with the development, deployment, analysis, and reporting of the survey please specify that here.

Who will receive the findings report from this survey and how will the findings be used?*

Please provide evidence of IRB approval (if applicable)

Browse and Upload Files

Upload a copy of the IRB Approval Letter

Description of any planned incentive program for respondents*

Please provide current draft of survey and all invitation and cover letters.

Browse and Upload Files

Status of Request:

Approved without ConditionsNot ApprovedApproved with Conditions

Decision Date

Date

OIE Conditions Note: