Permission to utilize non-BSU human subjects
Permission to utilize your college/university students as survey participants
Based on over 20 years of informal health priorities research at a state university, the National Health Priorities Project (NHPP) has expanded to become a national research endeavor.
The purposes of the NHPP are to:
- Expand student knowledge and understanding of health by examining the 13 components of health.
- Identify individual student health priorities by ranking these 13 health components via SurveyMonkey, an electronic survey.
- Identify the levels of satisfaction individual students have regarding their 13 health components by utilizing the Quality of Health Component Numbers (QHCN) tool.
- Compile individual student QHCNs via a weighted regressive mathematical model to create individualized Quality of Life Indexes (this is accomplished on our end).
- Besides accumulating these results, differences between and within groups will be cross tabulated.
All student responses are private and anonymous. Invitations to participate are without student email information and further anonymity is garnered by SurveyMonkey's IP identification switch being in the off mode. This survey has been approved by the Institutional Review Board at Minnesota's Bemidji State University (BSU), 218-755-2027, email@example.com.
I am asking permission for my survey to be electronically available to your students via my contact at your college/university (tba_______________________). The survey consists of 20 questions; three of them will take considerable thought, while the rest are demographic. I estimate the survey (10-15 minutes), protocol video (12 minutes) and debriefing (45 minutes) will take a little more than an hour. My contact at your institution will receive a pdf of the your students survey results within one day of the designated completion date. Only aggregate data will be provided, no individual data; nor will your institution be identified in any way. Further information on the NHPP can be found at: https://karlsalscheider.efoliomn.com My contact person at your university has permission to utilize my survey at no charge for future academic exercises. I have attached a copy of my survey for your review.
The signature below from your institutional representative indicates approval for Dr. Karl W. Salscheider to utilize your students for this survey pending their individual permissions.
____________________________________ __________________________ ________
Signature of Institutional Representative (IR) Printed Name of IR Date
Please make a pdf of this signed document and send to: firstname.lastname@example.org
Thank you for your participation!
Dr. Karl W. Salscheider, NHPP Director, BSU Professor Emeritus of Health,
30693 US Highway 2, Cass Lake, MN 56633 (218-760-3281)