NCS Research Survey Submission Form
Based on our experience, it is highly recommended for investigators to put forward incentive. This can be done as a lottery where participants will have the opportunity to voluntarily provide their contact information.  
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Email *
Contact Information: Name *
Title *
Institution *
Phone Number
Survey Title *
Provide a link to your survey/survey questions for review *
Describe the background of the survey (include citation of relevant literature and the gap the survey will address) (max 500 words) *
Describe the aims of the study (max 250 words) *
Describe what methods that you utilized for the survey development? (max 250 words) *
Describe the data analysis plan (max 250 words) *
Describe the significance and implications of this study (include impact and importance of the survey for professional practice and/or policy in relation to the current body of literature or state of practice) (max 300 words) *
Provide IRB approval date *
MM
/
DD
/
YYYY
Enter your IRB approval number
Specify the target audience (Select any that apply) *
Required
  Enter approximate duration of survey (minutes)   *
List any other routes of survey dissemination in the past or the future *
Specify any conflicts of interest
List any sources of funding, if applicable
List any protected health information or other identifiers collected in survey
Based on our experience, it is highly recommended for investigators to put forward incentive. This should be done as a lottery where participants will have the opportunity to voluntarily provide their contact information. Do you plan to put forward an incentive to survey responders?
A copy of your responses will be emailed to the address you provided.
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