PSCRP Part 4


Due Dates for Step 4:
  • Survey Draft due February 27th.
  • Consent Form Draft due February 27th.
  • Pilot survey during the week of March 2nd and obtain feedback due by March 6th.
  • Revised survey due March 9th
Instructions for Step 4 of the PSCRP
  1. Create and write up a survey and consent form based on your research project.
  2. Pilot the survey to your classmates and obtain written feedback.
  3. Amend the survey based on pilot results.
  4. Obtain survey approval and consent form approval from Mr. Izzy and Ms. Grogan.
Instructions for Writing the Survey
  1. Start with a short introduction to your survey about its purpose and objectives.
  2. Give your survey a title and provide the name of your group.
  3. Don’t write leading questions.
  4. Put your questions in logical order.
  5. Use the same rating scale throughout the survey.
  6. Use open ended questions to collect qualitative data.
  7. Use closed ended questions to collect quantitative data. Please see the examples below.
  8. Conduct at least two one-on-one in depth interviews with a person enrolled in your study. You will need at least five open ended response questions.

Types of Survey Questions
Survey questions vary according to what type of information they are trying to collect from the respondents, and how this information will apply to the goals of the survey. There are two basic types of survey questions: Open-ended and Closed-ended.


This type of question allows participants to respond in any way they choose. Open-ended questions provide primarily qualitative data, and are frequently used in exploratory research.
What is your current marital status?
A: [Participants provide answers in their own words]

In contrast to open-ended questions, closed-ended questions require participants to choose from a limited number of responses predetermined by the researcher. There are 5 basic types of closed-ended questions: Multiple-choice; Categorical; Likert-scale; Numerical; and Ordinal. Closed-ended questions provide primarily quantitative data, and are frequently used in confirmatory research.

Multiple Choice: 

Use a multiple-choice question when you want your respondents to choose the best possible answer among all options presented.
What is your current marital status? (Select one.) 

Use a categorical question when the possible answers are categories, and the respondent must belong to one category.

What is your gender?


 Use a Likert-scale question when you are trying to determine respondents’ attitudes or feelings about something.

How important do you think SAT scores are to a college student’s success? (select one):
Not very important 1 2 3 4 5 Extremely important

: Sometimes you may want your respondents to rank order their responses. A ranking indicates the importance assigned by a participant to attitudinal object.

Please rank the importance of the following qualities in a team leader. (Please fill in your rank order in the spaces provided using the numbers 1 through 5) 
A team leader that is sincere 
A team leader that gets resources for the team 
A team leader that is an advocate for the team 
A team leader that is a strong disciplinarian 
A team leader that is a good motivator

: When the answer must be a number, ask a numerical question.

What is your current age? (select one) 
Less than 18 
18 to 29 
30 to 39 
40 to 49 
50 or older or you can have the respondent write in their age.

Components of a consent form

Social scientists believe that a great deal of potential harm can be avoided by obtaining informed consent of research subjects prior to the research. In essence, informed consent means that subjects are aware of the following:
  • They are the subjects of a research project
  • The purpose of the research
  • Forewarned about what their participation will involve
  • Not forced in any way to participate
  • Are given the opportunity to withdraw their participation at any time
Research practices that violate the principle of informed consent include those that involve deception and/or coercion. The two are related in the sense that if a researcher does not tell people that they are being studied (deception), the researcher is therefore forcing the people to participate (coercion). Coercion can occur by itself when people are made aware that they are the subjects of research but not given the option of non-participation. While some professional researchers do use deceptive and coercive research practices, these are currently very controversial in the social science community and researchers who engage in such practices are expected to justify them by demonstrating that their research has great social benefits. Additionally, these kinds of proposed research projects often face opposition when presented to institutional committees that approve and/or sponsor research.

Essential Information on Consent Forms

  • All research protocols submitted to the IRB shall include a proposed participant consent form with the heading “Informed Consent to Participate in Human Subject Research.” The form shall, at a minimum, include the following requirements:
  1. A fair explanation of the procedures to be followed and their purposes, including Identification of any procedures that are experimental, the expected duration of the subject’s participation, and the identity of those persons primarily responsible for conducting the research and analysis of the data gathered;
  2. A description of any reasonably foreseeable discomforts and risks to the subjects as well as any safeguards or treatment available to the subject should distress or injury occur;
  3. A description of any benefits to the subject or to others in general which may reasonably be expected from the research;
  4. A disclosure, if appropriate, that other alternative procedures or courses of treatment exist in addition to those employed in the research that might be advantageous to the subject;
  5. A statement explaining to the subject efforts to be employed by the researchers to maintain the confidentiality of records produced during the research identifying the subject;
  6. An offer to answer any inquiries concerning the procedures with specific information about who to contact with pertinent information (address, phone number);
  7. An instruction that participation is voluntary, that the subject may discontinue participation or may refuse continuing participation without penalty or loss of benefits to which the subject is otherwise entitled, and that all data collected up to that point will be destroyed;
  8. A signature and date line for the subject, or the subject’s legally authorized representative, documenting that the subject has read and understands the consent given, that participation is voluntary and that no promises or threats have been made to or against the subject to obtain the subject’s consent to participate.
  • The agreement, written or oral, entered into by the subject should include no exculpatory language through which the subject is made to waive or to appear to waive any of his or her legal rights, or to release the institution or its agents from liability for negligence.
  • Informed consent must be documented. A copy of the signed informed consent form must be obtained from each subject for the principle Representative. The subject's copy must include the name, address, and telephone number of the person to whom complaints or reports of injury may be addressed.

Example: Informed consent for an interview conducted as part of a class assignment.

Informed Consent

I am a student in the Fall 2005 Adult Development course at Dominican University in River Forest, IL. I am conducting a developmental interview as part of a course assignment.
You have been asked to participate in this interview to describe experiences in your development during your adulthood, particularly notable developmental milestones (e.g., events viewed as significant factors, turning point or shifts relative to physical health, etc.). This is not a clinical or diagnostic interview. You may refuse to answer any questions you wish, without explanation.

The interview is confidential and your anonymity will be maintained throughout my project. I will not include any information in my paper or class presentation that will identify you.

Your participation in this interview is completely voluntary and you will not receive any compensation for your time. You may refuse to participate in this interview or discontinue participation at any time without penalty.

The interview will last approximately one hour. I would like to tape record your responses to my questions so I can listen carefully to what you have to say and not have to take notes. I will destroy the audio tape recording of this interview as soon as my paper is completed. If you do not want me to audiotape your responses, then I will just take notes.

If you have any questions about this project, you may contact my instructor, Dr. Theresa Schultz at 708-524-6909, or the Dominican University Institutional Review Board Chair, Dr. Charles Stoops at 708 366-3288 or email
I have read the above information and I voluntarily agree to participate in the developmental interview described herein.
Print Name: _______________________________________
Signature: ________________________________________ Date _________

The questions below can help you develop your own informed consent form.
  1. Is the general purpose of the study stated?
  2. Is the subject’s right to choose to participate indicated?
  3. Is there a statement indicating why and how a subject was selected as a possible participant?
  4. Are the procedures to be followed in the study clearly described (time, frequency, nature of information asked, observations, etc.)?
  5. Is there a statement of possible risks, discomforts or inconveniences that the participants may reasonably expect?
  6. Are any substantial or likely benefits to subjects identified?
  7. Is there any standard treatment withheld or alternative procedures available disclosed?
  8. Is subject confidentiality explained? (Use of tapes, photos, data, etc.)
  9. Are subjects’ compensation and costs of participating in the study identified?
  10. Is the subject told how to contact the investigator to have questions answered?
  11. Is the subject told how to contact the IRB chair to have questions answered?
  12. Is the subject’s right to a written copy of the consent form stated?
  13. Is there a statement that expresses that the individual’s signature indicates a willingness to participate?
  14. Are the appropriate signature and date spaces included?

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