Survey Request Intake Form

Do you need a survey? Please answer the questions below and we will begin the preliminary steps right away!

Question Title

* 1. Do you have a possible name for your survey?

Question Title

* 2. What information do you hope to obtain with this survey?

Question Title

* 3. This survey is intended for: (choose all that apply)

KC employees

KC students

External individuals

Another (or more specific) group:

Question Title

* 4. Please tell us about your survey questions:

I have a list of survey questions already prepared.

I would like assistance building survey questions.

Question Title

* 5. Please upload a PDF or Word document of your prepared survey questions.

PDF, DOC, DOCX file types only.

Choose File

Question Title

* 6. Do you believe your survey could require IRB (Institutional Review Board) approval?

If your survey involves (1) human participants in a way that includes collecting personal, identifiable, or sensitive data; (2) data to be used for research purposes or to publish; or (3) will be administered to participants under 18 years of age or belonging to a vulnerable population, then you will need IRB (Institutional Review Board) approval, as well.

Yes

Unsure

Question Title

* 7. Results Data:

When do you need the RESULTS data from this survey? (approximate is fine; this can be changed later)

Date

Survey Request Intake Form

Question Title

* 1. Do you have a possible name for your survey?

Question Title

* 2. What information do you hope to obtain with this survey?

Question Title

* 3. This survey is intended for: (choose all that apply)

Question Title

* 4. Please tell us about your survey questions:

Question Title

* 5. Please upload a PDF or Word document of your prepared survey questions.

Question Title

Question Title

* 7. Results Data:

Question Title

* 8. Who will be using the results from the collected data?

Question Title

* 9. What will they be using the information to do or accomplish?

Question Title

* 10. Who is the primary contact for building/managing this survey?

Question Title

* 11. Primary Contact Email address:

Question Title

* 12. Primary Contact KC Phone Number: