ABEA Survey Request Form
First Name
*
Last Name
*
Credentials
*
E-mail
*
Institution or Company
*
ABEA Member Sponsor of Survey
*
Title of Survey
*
What is/are the objective(s) of this survey
*
What do the author(s) expect data to be collected from this survey to show
*
How will the data collected as a result of this study be used specifically? i.e. grants, manuscripts, presentations, etc.
*
How will this survey contribute to the otolaryngology field and/or literature
*
Please provide a brief summary of the proposed statistical analyses to interpret the data collected and a letter of support from the statistical consultant performing these analysis
*
Date of IRB submission
*
-
Month
-
Day
Year
Date
How many total questions? How long to completion (minutes)
*
Please upload letter of approval or exemption for IRB
*
Browse Files
Cancel
of
Please upload letter of support from ABEA member (if not the same as the submitted)
*
Browse Files
Cancel
of
Please upload de-identified PDF introduction section and survey for blinded review
*
Browse Files
Cancel
of
Please upload the online version of the survey
*
Preview PDF
Submit
Should be Empty: