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