Institutional Research Data/Survey Request Form

In order to assure that our survey activities are effectively coordinated, that results are reliable and that efforts are not redundant, the Office of Institutional Research will review and approve all proposed surveys. If you are unsure or unable to provide a response to one of the optional questions, please leave it blank.                          ________________________________________________________________________________________________________

Contact Information

Name of requestor:

Title:

Division:

Department:

Alternate Point of Contact:

Details of Request

Descriptive name for the project or survey:

What are the objectives of the research?

Purpose: (check all that apply)

Federal requirement

State requirement

Strategic planning

Assessment

Professional research

Decision support

Trend analysis

Other

Please specify "other".

From which population do you want to collect information? (check all that apply)

First-Years

Sophomores

Juniors

Seniors

Faculty

Admistration

Staff

Alumni

Other

Please specify which alumni classes.

Please specify "other".

Distribution of results: (check all that apply)

Personal research, with intent to publish

Personal research, with no intent to publish

Divisions or departments on campus

College senior leaders

Trustees

Students

Alumni

Other internal individuals or groups

External indivlduals or agencies

Please specify which alumni classes.

Please specify which other internal individuals or groups.

Please specify which external indivlduals or agencies.

Data Source: (check all that apply)

Existing data (i.e. Banner, Recruitment Plus, Registrar's office, IR archives, etc.)

Survey Instrument

Focus group

I don't know

Other

Please specify "other".

Survey Details

Please identify the "existing data source" to the best of your knowledge.  (check all that apply)

Institutional Research archives

Banner

Recruitment Plus

Registrar

College Advancement data warehouse

Unsure

Other

Please specify "other".

Has this request been sent to the Institutional Review Board (IRB)? (Follow this link to learn more about the IRB).

Yes

No

Did the IRB approve this project?

Yes

Not yet, it is still being reviewed

It was disapproved, and it is, or will be revised and resubmitted

Other

Please specify "other".

Please indicate why this has not been sent to the IRB:

It is exempt

It has just not been submitted yet

Other

Please specify "other".

Is there a direct cost to administer the survey?

Yes

No

Unsure

Please specify the cost.

Please indicate who is responsible for the cost of the survey.

Do you have a requested sample size for the survey?

Entire population (census)

Random Sample

Unsure

Please specify the desired proportion for the sample.

Please provide any additional comments necessary regarding the sample size.

Survey Format:  (check all that apply)

Online

Hardcopy

Telephone

Other

Please specify "other".

Is this a new survey or an existing survey?

This is a new survey

This is an existing survey and I have no, or few changes

This is an existing survey, but I have significant changes

Is there a rough draft (in any form)?

No

Yes, I have a draft in MS Word

Yes, I have a draft as a PDF

Yes, I have a draft in hardcopy form

Key Dates

When do you want to deploy the survey? (MM/DD/YYYY)

Typically we leave a survey open for 3 to 4 weeks.  Will this work for you?

Yes

Unsure

No

Please specify the desired length of time for the survey to remain open.

Typically we send an initial invitation and two reminders.  Will this work for you?

Yes

Unsure

No

Please indicate your preferred number of reminders

From which office would you like the invitation and reminders sent?

My office (the division and/or department shown above)

Institutional Research "Dickinson Voice"

It doesn't matter to me

Other

Please specify "other".

Focus Groups

How many focus groups?

Describe in detail the makeup for each focus group. (i.e. 12 Juniors who have studied abroad, even gender mix)

Dates to conduct focus groups?

Length of time required for each group?

The location for focus groups has been or will be coordinated by requestor.

Yes

No

Facilitators

Do you need help to identify them?

Yes

No

Do you need help to train them?

Yes

No

Do you need help to record discussion (person or equipment)?

Yes

No

Analysis What level of analysis is needed?

Raw data only

Frequencies and descriptive data, no narrative

Frequencies and descriptive data, with narrative summary

Full study report with data tables and narrative

Other (please specify)

Please specify "other"

Date requested for the final analysis requested above. (MM/DD/YYYY)

Can you provide any information on what others have done on the topic?  (historical info, other published surveys, literature review etc.).

Please list any additional requests or instructions.

Thank you for your time. Click the "Submit" button below to send your request.