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Authorization to Conduct Survey Research
Name:
Department:
Title:
Phone #:
Email:
Purpose for the proposed survey research:
What is the target population?
Student
Faculty
Staff
Other
*Proposed sample size and method of selecting sample:
Administration techniques?
Mail
Phone
In-class
Web-based
Other
Does this research require approval from the Human Subject Review Committee of the Institutional Review Board?
Yes
No
If so, has it been approved?
Yes
No
N/A
When do you plan to administer the survey or conduct the survey research?
What is the proposed timeframe of data collection?
*How will you analyze the survey results?
*How will you use the survey results?
Attach copy of the survey or other data collection instrument via email to
iea@fau.edu
or mail to SO 303.
*The Office of Institutional Effectiveness and Analysis can offer technical assistance with these aspects of your survey research at no cost to you.
If you have problems with this form please contact us at 561.297.2665 or
iea@fau.edu
Revised: September 25, 2007
