Research Survey Request Form

  • * Note: All fields with an asterisk in their label are required fields.

  • Contact Information

  • Survey Request Information

  • MM slash DD slash YYYY
    See Submission Instructions below for a list of required attachments.
  • (i.e. principal investigator or faculty sponsor)
  • (e.g. power analysis)
  • (Include both internal and external funding sources.)
  • Note: (Please include the following in your answer, above:  1) How long do you plan to collect data?  2) When are you hoping to have the data collected, analyzed, and ready for dissemination?)
  • Agreements

  • I understand that if the APOSW Research Committee approves me to invite members of APOSW to participate in this research, this study can be posted to the APOSW-List listserve a maximum of three times within six months of approval.
  • I further agree to submit a payment of a one-time $50.00 charge for three postings (APOSW members) or a one-time $200.00 charge for three postings (non-APOSW members).
  • Electronic Signature

  • Please re-enter your name to confirm that this serves as your electronic signature.
  • MM slash DD slash YYYY
  • Submission Instructions

    Upon submission of this form, you will receive an email confirmation, which will contain instructions for submission of your required attachment documents.

    Your Research Survey Request cannot be considered until the following required documents have also been received.

    These include copies of the following:
    1) IRB Proposal
    2) IRB Approval Letter
    3) Final Survey Instrument or link to Online Survey, along with accompanying correspondence.

    Please submit all required documents in Adobe PDF format.

    Download, print and save a copy of the Research Survey Request Form Instructions (PDF)

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