Request to Disseminate Survey/Information by Individual or Organization 2022-23
MSNO organization's mission is to promote and advance quality school health services throughout the Commonwealth and to promote the rights, interests and professional growth of our members.
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Email *
Your Name *
Contact person/organization email address *
Title of study/project/information *
Name of person's affiliated organization *
Date of Request *
Is the organization a non-profit? *
What is the organization's mission? *
Is the organization's mission aligned with MSNO's mission? *
Is the person requesting for graduate (nursing) studies? *
Has the study/project been approved by the organization's IRB? *
If you answered Yes to previous question, please provide IRB approval # and organizations
Is the person requesting to promote their own organization's programs and services? *
Has the person requesting survey/info distribution an MSNO member (not required)? *
How would disseminating survey/information benefit MSNO members? *
Will requester agree to acknowledge MSNO in publications from study? *
Requester is asking for distribution of information via (check all that apply): *
If you responded 'Other' to previous question, please explain: *
Sample of brief description of request to be considered for inclusion in MSNO communications (no more than 3-4 sentences, including contact information for person requesting): *
Thank you for your request.
MSNO is a non-profit organization managed by an all volunteer board. Your request will be reviewed by the MSNO Executive Committee and a response will be provided as soon as time allows. Thank you for your patience.  
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