Survey Intake Form

Please enter your name:*

First Last

Please enter your email address:*

Check here if person submitting form is different from individual responsible for the survey

Who is the individual responsible for this survey?*

What is their email address?*

Which campus is this for?*

Select All
Milwaukee (Main Campus)
Washington County
Waukesha

What division is responsible for this survey?*

What department is responsible for this survey?*

What is the title of the survey?*

Is there a cost to the institution associated with this survey?*

Yes
No

How much is the cost?

Which department/unit is responsible for paying this cost?*

What does this cost cover (examples: access to survey instrument and results, marketing/publicity, incentives)?

Is additional funding needed to administer this survey?*

Yes
No

How much additional funding is needed?*

Who are the recipients of this survey (e.g. new freshmen, all undergraduates, master's students, associate degree students, bachelor degree students, etc.)?**

What is the estimated length of time it will take respondents to complete this survey?*

What is the purpose/scope of this survey? (For example: What question are you trying to answer? How will this survey benefit the student experience at UWM?)*

Will this survey be implemented by a third party?

Yes
No

Please list the third-party who will implement the survey:

Has a data sharing agreement with the third party been approved by UWM's Office of Legal Affairs?

Yes
No

Please upload the signed data sharing agreement:*

Max. file size: 5 MB.

How will this survey be administered?*

What is the timeline for survey implementation, assessment, and distribution of results?

How often will this survey be administered (each semester, annually)?*

Has this survey been administered before?*

Yes
No

When was this survey last administered?*

Does this survey require IRB approval? Please see this resource from the IRB: https://uwm.edu/irb/submission/do-you-need-to-submit-to-the-irb/*

Yes
No
Unsure

Has the survey been approved by the IRB?*

Yes
No

Please upload your IRBManager Protocol Form:*

Max. file size: 5 MB.

How will results be communicated to campus/various stakeholders?*

Will additional units be informed/impacted by the results of this survey?*

Yes
No

Please list the units who will be informed/impacted by the results of this survey:*

Please enter any additional notes below: