ACNM Survey Research Request Form
2025
Principal Investigator:
First Name
Last Name
Title of Proposal:
Email
*
example@example.com
All of the requested materials have been submitted. (If NO, do not continue.)
YES
NO
COVER LETTER
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...or upload cover letter here:
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Upload copy of appropriate Institutional Review Board approval
*
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Upload curriculum vita of the researcher
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CV of the faculty member overseeing the project if it is a student project/study
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Please upload PDF of survey:
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The ACNM membership is an appropriate subject/respondent group for the proposed research
Yes
No
The materials contain adequate evidence of the appropriate measures to protect the privacy of CNMs/CMs and SNMs/SMs who respond and the confidentiality of those responses
Yes
No
For student applicants, there is evidence that a faculty advisor has reviewed the proposal and assumes supervisory responsibility for the proposed research
Yes
No
N/A (not a student)
If you have any questions please email researchsurveys@acnm.org
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