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Application for an Anonymous Survey

By Federal law and guidelines and Clark University policy, all institutional and research surveys by Clark faculty, research personnel, students and staff must be reviewed and approved by the Institutional Review Board for Research Involving Human Subjects (IRB).

If the survey is not anonymous, the project must be described in the usual form,  Application for Projects with Human Subjects, and reviewed by the full IRB.

If the survey is anonymous, it is eligible for expedited review. Expedited reviews are conducted on a rolling basis; you do not need to wait for a regular IRB meeting date. Anonymous survey submissions must include:

  • an application that briefly addresses steps 1-7
  • a copy of the survey instrument. The survey instrument must include an introductory statement with the elements listed in step 8 below. This statement should include at the end the following text for all anonymous surveys: "This study has been approved by the Clark Committee for the Rights of Human Participants in Research and Training Programs (IRB). Any questions about human rights issues should be directed to the IRB Chair, Dr. Robert Johnston at 508-751-4619."

You will need to specify how your instrument will be administered in step 2 below. If the survey will be conducted electronically, Clark's web-based survey software, Qualtrics, must be used. If your methodology requires functionality that is not available in Qualtrics, ITS Staff may assist in evaluating the availability of the feature and alternative survey solutions. When collecting web data there are unique challenges to ensuring respondent anonymity; ITS staff will help ensure Qualtrics is configured in accordance with IRB standard protocol. To determine if Qualtrics will support your research methodology, visit the Survey Support section of the ITS web site.



Provide Contact Information

Is this a survey for the STAIR office? (yes or no) Yes:    No:

Provide Information About Your Survey









8.  The Survey Form

Forward an electronic link with all the survey questions to:, or paper copy of the survey document to Linda Cote, RESEARCH OFFICE, RM. 300, Geography Building (ext. 3880) It should include a statement to the participants describing

  1. the purpose of the survey
  2. the names, affiliations, and contact information of the surveyors (undergraduate or graduate status if you are a student)
  3. the duration of time needed to complete the survey.

It should also include statements that:  

  1. the survey is anonymous
  2. responses cannot be traced back to participants
  3. participation is voluntary
  4. any question may be left unanswered
  5. the participant can drop out at any time
  6. that respondents should not put any identifying information about themselves on the survey.