Acha Institution Of Higher Education Demographic Survey Form (Page 3 of 5) in pdf

Acha Institution Of Higher Education Demographic Survey Form Page 3

Section 1, Continued. Institutional Characteristics

11. C

AMPUS

OCALE

Very large city (population over 500,000)

Large city (population of 250,000 - 499,999)

Small city (population of 50,000 - 249,999)

Large town (population of 10,000 - 49,999)

Small town (population of 2,500 - 9,999)

Rural community (population under 2,500)

12. C

AMPUS

EALTH

NSURANCE

ODEL

We offer no form of student health insurance and students are responsible for their own coverage

Voluntary (Students have the option of purchasing your institution’s health insurance plan but are not required

to show any proof of insurance to your institution)

Soft Waiver (Students are mandated to have health insurance coverage comparable to your institution’s plan, and

if so, they may waive your institutional plan without proof of alternative coverage)

Hard Waiver (Students are mandated to have health insurance coverage comparable to your institution’s plan,

and if so, they may waive your institutional plan with proof of alternate coverage)

Mandatory (All students are mandated to purchase your institution’s student health insurance regardless of

outside insurance coverage)

Other (Please specify: ______________________________________________________________________)

Section 2. Survey Characteristics

1. P

URPOSE OF

URVEY

Pre-test (e.g., before educational program or campus-wide intervention)

Post-test (e.g., after educational program or campus-wide intervention)

General assessment of student beliefs, behaviors, and experiences

Other (Please specify: ______________________________________________________________________)

2. D

ATE

DMINISTERED

Start date

End date

3. S

(I surveyed…)

TUDENT

AMPLE

HARACTERISTICS

All of the different types of students who attend my institution

Only a particular group of students (e.g., undergraduates, freshmen, athletes, medical students,

commuters) (Please specify: _________________________________________________________________)

4. I

NCENTIVES

Students who completed the ACHA-NCHA were entered into a random drawing for an incentive

(Pease specify incentive: ___________________________________________________________________)

All students who completed the ACHA-NCHA received an incentive

(Please specify incentive: ___________________________________________________________________)

I did not offer students who completed the ACHA-NCHA an incentive for their participation

5. S

(I surveyed using…)

URVEY

YPE

Paper-based surveys (Complete Section 2A on the next page)

Online/Web-based surveys (Complete Section 2B on the next page)

Page 3 of 5

Acha Institution Of Higher Education Demographic Survey Form Page 3

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