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UWM Survey Intake Form

UWM Survey Intake Form

To request that a survey be sent to UWM students, please complete the form below. Review the criteria for submission before submitting a request:

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:

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