REACH Survey Report Request
This form must be completed in order to receive your REACH survey reports. A separate form for each participating site is required if multiple site reports are needed.
Email address *
Survey Coordinator Name *
Title
Organization *
City, State, Zip Code *
Phone *
Email *
If different from above, please provide the following information for the school, organization, or program participating in the survey. If there are multiple participating organizations, please submit a form for each.
(Organization Name, City, State, Zip)
What grades were surveyed? *
Required
What type of consent was used? *
Is this your pre- or post-assessment? *
Please enter the EXACT date when data entry began--It's critical that these dates are accurate as they dictate which data are included in the reports. *
MM
/
DD
/
YYYY
Please enter the EXACT date when data entry was completed--It's critical that these dates are accurate as they dictate which data are included in the reports. *
MM
/
DD
/
YYYY
Please estimate the number of young people who participated in the survey. *
This will help our research team reconcile the number of participants in the survey system and your best guess.
Please enter your unique survey ID (5-digit code provided in the email with your survey link) *
Any additional notes for our researchers? (customization, instructions, etc.)
Submit
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