Survey Dissemination Request Form

Proposed Start Date*

Proposed End Date*

Date

Who will this survey be distributed to?*

Who should take this survey? (check all that apply)*

Please describe in detail the purpose of this survey and how it aligns with SMSNA:*

Please provide a link to your questionnaire:*

(questionnaire must be in the form of an online submission, such as Survey Monkey, Google Forms, etc.)

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After submitting this form, please allow for a minimum of two weeks for a response, as your request and questionnaire will be reviewed by the SMSNA Educational Projects Committee prior to approval.

Please also note that the timing and duration of the survey to be included on the SMSNA website must not exceed 3 months or one quarter. If it exceeds this time, full Board approval would be required and additional expenses may be incurred.

By signing below, I acknowledge the above statements.*

Today's date*

Date

Survey Dissemination Request Form

SMSNA Member Request

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