External Survey Request Form

The University of Mobile has instituted a policy to evaluate all survey requests from those outside the university and determine whether or not to grant access on a case-by-case basis.

As per university Regulation 6.4.a, any person not affiliated with UM wanting to administer a survey to UM students, alumni, faculty, staff, or administrators is required to complete the External Survey Request Form (ESR). The information provided in this form will be used to evaluate your project and make our determination. While you must complete the ESRF online here, it might be helpful to first review a PDF of it so you are aware of all the information you will be asked to provide.

Please allow up to two weeks for UM to process your request (this will take longer for requests made during the summer and other academic breaks). For more information about the survey registration process contact the IRB chair at ghollingsworth@umobile.edu.

First / Last name

Title

Your institution/organization

Your unit/department or campus organization

Your email

Please select

If you selected "other" please describe below

Please briefly describe your education and/or experience as it relates to developing and/or administering surveys.

What, if any, connection do you personally have with the University of Mobile? (e.g., alumna/alumnus, former employee, none)

Descriptive name of the survey (e.g., "Graduating Senior Survey," "Faculty Satisfaction Survey")

Please briefly describe the purpose or goals of the proposed survey research project.

What general topics are included in the questionnaire?

Primary reason(s) for the survey (Mark all that apply)

Faculty Research

Doctoral Dissertation

Master's Thesis

Capstone or Honors Project

Student Class Project

Other (Please Describe)

Description

Is this part of a funded research project?

Yes (Please specify funding source)

Funding Source

Why is it important that University of Mobile students, faculty and/or staff participate in your survey project? That is, how is UM’s participation in particular helpful to your project, and what are the implications for your project if UM does not participate?

How would UM benefit from participating in your project?

Please describe any reports on results that you would be able to share with UM.

Have you been in contact with anyone at UM about your project?

Yes

With whom at UM have you been in contact about your project. (E.g., Name, title, office, email)

Please provide a brief summary of your discussion with this person about your project.

Which of the following best describes the status of your project with respect to approval from an Institutional Review Board (IRB)? Note that having IRB approval from your home institution does not guarantee that you will receive permission from UM to administer your survey to our students, faculty or staff.

The project has been approved by my home institution's or another institution's IRB

My local IRB will approve my project to be administered at UM after I provide documentation from UM that I have permission to do so

IRB determined that the project was "Exempt"

The project is currently under review by IRB

I have not yet submitted my project for IRB review, but plan to do so

The project does not fall under the purview of IRB

I do not know the IRB status of the project or am unfamiliar with IRB requirements

Other

Please provide a copy of the documentation you received from IRB indicating the project was approved or exempt. Note: Just attach just a copy of the letter/email you received from IRB, NOT the entire IRB proposal.

File / Image upload

Delete all uploads

Choose files or drag here

Please provide the contact information to whom confirmation that your project has been approved to be administered at UM. Should your project be approve, the IRB will submit the required documentation to this person/office.

Include: Name, Title, Office/Department, and Email

You indicated that your project does not fall under the purview of IRB. Please briefly explain.

You indicated that you are unfamiliar with Institutional Review Board (IRB) requirements. The IRB is responsible for ensuring the protection of human subjects in research. It is very possible that prior to administering your survey you are required by federal guidelines to have your project reviewed by IRB. Please familiarize yourself with the expectations for IRB review. Information is available about UM's IRB policies and processing by contacting the IRB chair at ghollingsworth@umobile.edu.

Please explain how you will protect the confidentiality of those participating in your survey project.

How will the survey be administered? (Mark all that apply)

Online

Self-administered paper/pencil

Telephone

Other (Please Describe)

If you marked "other" please describe below

On what date do you anticipate the survey 'going live,' and when will it close?

First Day - Last Day (MM/DD/YYYY)

How much time will be required of those participating in your survey project? I.e., How long does it take to complete the questionnaire?

Fewer than 5 minutes

5 to 9 minutes

10 to 19 minutes

20 to 29 minutes

30 to 44 minutes

45 to 59 minutes

60 minutes or more

Please read carefully!

It is exceedingly rare that any survey will be administered to literally everyone in the larger survey population (e.g., all undergraduates, all faculty). Rather, most surveys are targeted to a certain subset of the population, or are administered to a random sample of the larger population. This is particularly true for those outside of UM wanting to include members of our campus community in their survey. The IRB in consultation with UM Institutional Research can help you clarify your survey population, and work with you to select a random sample.

In the information you provide below, please clarify who you will be specifically targetting for inclusion in your survey. Please be aware that as per FERPA and other privacy protections, UM will not be able identify members of our campus community and provide you with contact information based on any protected statuses (e.g., by race/ethnicity, gender, citizenship status, age). If your target population is based on such protected statuses, it is possible, but by no means guaranteed, that we can work with you to distribute your survey.

Please specify which undergraduates will actually be invited to participate in your survey.

All undergraduates will be invited to participate

A random sample pulled from all undergraduates will be invited to participate (the IRB in consultation with UM Institutional Research can help select a random sample for you)

All undergraduates meeting the survey eligibility requirements will be invited to participate (e.g., only undergraduates in the College of Arts and Sciences; only Sophomores; only those enrolled in a certain course)

A random sample of those meeting the eligibility requirements will be invited (the IRB in consultation with UM Institutional Research can help select a random sample for you)

What are the eligibility requirements for an undergraduate to be included in your survey population and asked to participate? Please be as detailed as possible.

Please indicate the estimated number of undergraduate students that will be invited to participate in the survey. NOTE: This does not mean the number you think will ultimately participate in the survey, but how many you are wanting to tell about the survey and ask to participate in it.

Fewer than 50

50-99

100-249

250-499

500-99

1,000 or more

Please specify which graduate students will actually be invited to participate in your survey.

All graduate students will be invited to participate

A random sample pulled from all graduate students will be invited to participate (the IRB in consultation with UM Institutional Research can help select a random sample for you)

All graduate students meeting the survey eligibility requirements will be invited to participate (e.g., only graduate students in the College of Education; only Master's students; only those enrolled in a certain course)

A random sample of those meeting the eligibility requirements will be invited (the IRB in consultation with UM Institutional Research can help select a random sample for you)

What are the eligibility requirements for a graduate students to be included in your survey population and asked to participate? Please be as detailed as possible.

Please indicate the estimated number of graduate students that will be invited to participate in the survey. NOTE: This does not mean the number you think will ultimately participate in the survey, but how many you are going to tell about the survey and ask to participate in it.

Fewer than 25

25-49

50-74

75-99

100 or more

Please specify which alumni will actually be invited to participate in your survey.

All alumni will be invited to participate

A random sample pulled from all alumni will be invited to participate

All alumni meeting the survey eligibility requirements will be invited to participate (e.g., only alumni from the College of Education; only Master's degree recipients; only those participated in varsity sports)

A random sample of those meeting the eligibility requirements will be invited (the IRB in consultation with UM Institutional Research can help select a random sample for you)

What are the eligibility requirements for an alumna/alumnus to be included in your survey population and asked to participate? Please be as detailed as possible.

Please indicate the estimated number of alumni that will be invited to participate in the survey. NOTE: This does not mean the number you think will ultimately participate in the survey, but how many you are going to tell about the survey and ask to participate in it.

Fewer than 50

50-99

100-249

250-499

500-999

1,000-1,999

2,000-4,999

5,000-9,999

10,000 or more

Please specify which faculty will actually be invited to participate in your survey.

All faculty will be invited to participate

A random sample pulled from all faculty will be invited to participate

All faculty meeting the survey eligibility requirements will be invited to participate (e.g., only faculty in the College of Health Professions; only professional track faculty; only those teaching a distance education course)

A random sample of those meeting the eligibility requirements will be invited (the IRB in consultation with UM Institutional Research can help select a random sample for you)

What are the eligibility requirements for a faculty member to be included in your survey population and asked to participate? Please be as detailed as possible.

Please indicate the estimated number of faculty that will be invited to participate in the survey. NOTE: This does not mean the number you think will ultimately participate in the survey, but how many you are going to tell about the survey and ask to participate in it.

Fewer than 10

11-19

20-29

30-49

50-69

70 or more

Please specify which staff will actually be invited to participate in your survey.

All staff will be invited to participate

A random sample pulled from all staff will be invited to participate

All staff meeting the survey eligibility requirements will be invited to participate (e.g., only staff in the Alabama School of the Arts; only those working in temporary positions)

A random sample of those meeting the eligibility requirements will be invited (the IRB can help select a random sample for you)

What are the eligibility requirements for a staff member to be included in your survey population and asked toparticipate? Please be as detailed as possible.

Please indicate the estimated number of staff that will be invited to participate in the survey. NOTE: This does not mean the number you think will ultimately participate in the survey, but how many you are going to tell about the survey and ask to participate in it.

Fewer than 10

10-29

30-49

50-69

70 or more

Please specify which administrators will actually be invited to participate in your survey.

All administrators will be invited to participate

A random sample pulled from all administrators will be invited to participate

All administrators meeting the survey eligibility requirements will be invited to participate (e.g., only deans, only those who have been at UM less than five years)

A random sample of those meeting the eligibility requirements will be invited (the IRB in consultation with UM Institutional Research can help select a random sample for you)

What are the eligibility requirements for an administrator to be included in your survey population and asked toparticipate? Please be as detailed as possible.

Please indicate the estimated number of administrators that will be invited to participate in the survey. NOTE: This does not mean the number you think will ultimately participate in the survey, but how many you are going to tell about the survey and ask to participate in it.

Less than 10

10-29

30 or more

Please specify which other members of the UM campus community will actually be invited to participate in your survey.

All others as described above will be invited to participate

A random sample pulled from all those others as described above will be invited to participate

Please indicate the estimated number of other members of the campus community that will be invited to participate in the survey. NOTE: This does not mean the number you think will ultimately participate in the survey, but how manyyou are going to tell about the survey and ask to participate in it.

Less than 50

50-99

100-249

250-499

500-999

1,000-1,999

2,000 or more

As a rule, those not affiliated with UM who are granted permission to include our students, faculty, staff or administrators in the population for their survey are expected to directly contact those individuals to invite them to participate. The IRB in consultation with UM Institutional Research will work with you to identify the appropriate sample members, and provide you with their email addresses. Only under rare circumstances will anyone from UM contact survey population members on your behalf to inform them about your survey.

Would you like to request additional assistance -- other than being sent a file with email addresses for the selected survey population members -- for your project?

Yes

Please briefly describe why you need additional assistance from UM.

Which of the following types of assistance are you likely to be asking for?

Sending email announcements to those in the survey population on your behalf

Posting information about the survey to a listserv or in newsletters

Allowing faculty to make announcements about the survey in their class

Other (Please specify)

Additional Assistance Information

Please use the space below to provide any additional information you wish to share about this survey project.

Thank you for completing the External Survey Request Form. You can select "Previous" if you wish to review/edit your answers. When you click on "Submit" your form will be submitted. You will then see another page, then taken to a page with a pdf file of the information you have provided that you can save for your records.

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