This survey is being conducted by students of the Introduction to Sociology class at Texas Wesleyan. All answers are confidential - no names will ever be associated with the data. Please answer honestly and completely. Your participation is appreciated. Name, Name, Name, Name.
1. Gender
€ Female €
_______ Male _________
2. Age ________________
3. Race
Anglo _____€ African American _____€ Hispanic _____€ Other _____ €
4. Religion
Catholic _____€ Protestant _____ € Muslim _____€ Hindu _____€ Buddhist _____ € Other _____ €
5. To which class do you associate yourself with the most?
Upper class _____€ Middle class _____€ Working class _____€ Lower class _____ €
6. Major ________________________
7. Other questions pertinent to your study.
8.
9.
10.
HUMAN SUBJECTS FORM
Along with the survey you will need to fill out a Human Subjects form. This needs to be signed and returned with the survey (be sure to keep a copy of your survey). Here is an explanation of the information requested.
Sponsoring Department -
Sociology
Department
Principal Investigator -
Name,
Name, Name, Name
Faculty Sponsor -
Dr. Sara
Horsfall
Title of Project -
Your Title
Number and Source of Participants -
30 Texas
Wesleyan students (or other if you are not using students for your
data)
Proposed Date and Span of Project -
Semester
in which project is being done, e.g. Spring 2002
Purpose/Objective of Project -
To find
out .....; To confirm .........; (for instance, To find
out the level of discrimination felt by minority students at
Texas
Wesleyan.)
Description of the Project -
Thirty
students will be asked to voluntarily answer our survey. We will approach
them in the Student Union........
(Describe
how you plan to collect the data.)
Attendant risks and Proposed safeguards -
None
Procedure to Insure Confidentiality -
All surveys
are anonymous
Signature of Principal Investigator -
One or
more persons from the group should sign.