The Colorado School of Mines
Student Health Center & Insurance Survey
SURVEY INSTRUCTIONS

Colorado School of Mines is conducting an extensive study of student health care and insurance issues. You may be one of approximately 1,400 students who have been randomly selected to participate in this survey. This research effort will help us to evaluate the scope of health care services that are available on campus, including the possible addition of dental care services. For students who are covered by the CSM Student Health Benefits Plan (SHBP), we are interested in obtaining information about how we should use surplus funds that have been realized over the past three plan years.

If you have been selected to participate in the survey, you may only complete the survey one time. If you received a letter or email message from me inviting you to participate in the survey, and you cannot access the survey using the last six digits of your Student Identification number (your Student I.D. # may be your Social Security number), please contact the consultant for CSM, Stephen L. Beckley at: beckley@slba.com. You may also contact Mr. Beckley by telephone at 303-790-1884.

Following completion of your survey, your name will be entered into a drawing to win a $100 gift certificate at the CSM bookstore. We expect the survey will take you approximately 15 minutes to complete. The survey includes questions about your use of health care providers and ongoing health care conditions that require periodic treatment. You may preview the survey by using the Student Identification number: 123456.

The only inquiries that you are required to answer are the demographic questions one through 11 pertaining to sex, age, ethnicity, country of citizenship, etc., and question 24 ("Are you covered by the CSM Student Health Benefits Plan?"). You may leave any other question blank. When you click on the "submit" button at the bottom of each page, the survey software will call your attention to any questions you did not answer. You may then use the "back" button on your web browser to answer the question, or click on a "continue" button to bypass the question(s) you choose not to answer. If you inadvertently answer a question incorrectly, there is a button at the bottom of each page of the survey that allows you to clear all answers on that page.

Thank you for participating in this important research effort for Colorado School of Mines. Best wishes for good health and success in your academic endeavors.

This survey is now complete. Thanks for your participation


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