E-AHPBA Scientific & Research - Request to Circulate a Survey

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1. Survey Title (Required.)

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2. Date of Request (Required.)

Date / Time

Date

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3. Applicant Details: (Required.)

Name of Applicant

Position

Address

Address 2

City/Town

ZIP/Postal Code

Country

Email Address

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4. Is the Applicant an E-AHPBA member?

(Please note that either the applicant or a senior collaborating member of the team must be an E-AHPBA member) (Required.)

Yes

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5. Supervising Institution: (Required.)

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6. Supervising Mentor: (Required.)

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7. Team involved, their location(s) and E-AHPBA member status: (Required.)

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Upload any supporting documents for the team here:

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8. Scope of proposed survey: (Required.)

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9. Background and rationale of proposed survey: (Required.)

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Upload any supporting documents for the proposed survey here:

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10. Geographic area of survey: (Required.)

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11. A summary of the protocol demonstrating that the collection and analysis of data is consistent, reliable, repeatable, and appropriate to address the intended objective: (Required.)

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Upload any supporting documents for the summary of protocol here:

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12. Summary of intended use of data gathered, plan for publications: (Required.)

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Upload any supporting documents for the summary of intended use and plan for publications here:

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13. Please upload the questionnaire of the survey: (Required.)

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14. Will survey respondents be acknowledged as collaborators? (Required.)

Yes

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Acknowledgement: (Required.)

I confirm that I have read and understood the E-AHPBA Scientific & Research Endorsement Guidelines available on the E-AHPBA website and agree to adhere to the criteria outlined in this document.

I agree to provide project updates 6 months after endorsement and annually thereafter until completion or publication, and to acknowledge E-AHPBA support in all outputs.

Question Title

* 1. Survey Title (Required.)

Question Title

* 2. Date of Request (Required.)

Question Title

* 3. Applicant Details: (Required.)

Question Title

* 4. Is the Applicant an E-AHPBA member?(Please note that either the applicant or a senior collaborating member of the team must be an E-AHPBA member) (Required.)

Question Title

* 5. Supervising Institution: (Required.)

Question Title

* 6. Supervising Mentor: (Required.)

Question Title

* 7. Team involved, their location(s) and E-AHPBA member status: (Required.)

Question Title

* Upload any supporting documents for the team here:

Question Title

* 8. Scope of proposed survey: (Required.)

Question Title

* 9. Background and rationale of proposed survey: (Required.)

Question Title

* Upload any supporting documents for the proposed survey here:

Question Title

* 10. Geographic area of survey: (Required.)

Question Title

* 11. A summary of the protocol demonstrating that the collection and analysis of data is consistent, reliable, repeatable, and appropriate to address the intended objective: (Required.)

Question Title

* Upload any supporting documents for the summary of protocol here:

Question Title

* 12. Summary of intended use of data gathered, plan for publications: (Required.)

Question Title

* Upload any supporting documents for the summary of intended use and plan for publications here:

Question Title

* 13. Please upload the questionnaire of the survey: (Required.)

Question Title

* 14. Will survey respondents be acknowledged as collaborators? (Required.)

Question Title

* Acknowledgement: (Required.)

1. Survey Title (Required.)

2. Date of Request (Required.)

3. Applicant Details: (Required.)

4. Is the Applicant an E-AHPBA member?

(Please note that either the applicant or a senior collaborating member of the team must be an E-AHPBA member) (Required.)

5. Supervising Institution: (Required.)

6. Supervising Mentor: (Required.)

7. Team involved, their location(s) and E-AHPBA member status: (Required.)

Upload any supporting documents for the team here:

8. Scope of proposed survey: (Required.)

9. Background and rationale of proposed survey: (Required.)

Upload any supporting documents for the proposed survey here:

10. Geographic area of survey: (Required.)

11. A summary of the protocol demonstrating that the collection and analysis of data is consistent, reliable, repeatable, and appropriate to address the intended objective: (Required.)

Upload any supporting documents for the summary of protocol here:

12. Summary of intended use of data gathered, plan for publications: (Required.)

Upload any supporting documents for the summary of intended use and plan for publications here:

13. Please upload the questionnaire of the survey: (Required.)

14. Will survey respondents be acknowledged as collaborators? (Required.)

Acknowledgement: (Required.)