Note - Please Complete the form below to submit you request to conduct a survey project. An IR staff member will contact you within 5 business days after submitting your request.

* - Denotes Required Fields.

Security Code

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Six Character Code. Only Capital Letters and Numbers are used.

Code: *

Survey Purpose

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This Survey Project is for:

Departmental Work University Committee Work Personal Research

Contact Information

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Contact Person: *
Phone: *
Email: *
Campus Address:

Survey Information

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Name of Survey Project:
Requested Launch Date:	(must be at least two weeks after today's date)
Requested Close Date:	(recommend surveys active for two weeks)

Note: Survey results will be distributed two weeks after the close date.

Method of Distribution:
E-mail	E-mail and Letter
Letter	Not Sure

Rationale for project: (Please include a description of the group of people you wish to survey, i.e. Students, Faculty, Freshmen, etc.)

Text for Invitation Email Text:

Thank you Page - If you want text for the thank you page enter it here, if you want respondents directed to a website enter the URL here:

Email Addresses of those individuals you want to receive the survey. (If currently available)

If you have technical difficulties accessing or submitting this form please contact The Office of Institutional Research at 859-622-2015.