ABEA Survey Request Form
Name
*
First Name
Last Name
Email
example@example.com
Title of Survey
Deadline for Survey responses
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
ABEA member submitting Survey/ABEA member sponsor 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 analyst.
Which member group(s) of the ABEA would you like this survey distributed to:(select all that apply)
Active members
Senior members
Associate members
Honorary members
International members
Candidate members
Physicians in-training
Please upload a letter of support from the ABEA member acting as the survey sponsor.
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Please upload a full copy of the planned survey, de-identified.
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