Submit A Survey

Survey Contact Name *

Survey Contact Email *

Survey Contact Phone Number *

Survey Title *

Link to Survey Instrument (if available)

Survey Information Page / Home page (if available)

What is the earliest possible preferred start date? *

What is the last possible day for the survey to close for your project? *

How long do you plan to administer the survey? *

Provide a brief description of the survey, in terms that can be understood by those unfamiliar with the project or research.*

How will the survey results be used?*

How will the survey results be stored?*

Georgia Tech endorses Cybersecurity approved Qualtrics as the Institute Survey Platform, https://academiceffectiveness.gatech.edu/survey-toolkit/. What survey tool will be used? *

How and when will the survey data be destroyed? *

Who are you trying to contact for this survey? What group of people or specific subgroups are you trying to reach?*

How many students do you intend to contact?*

Communication Plan: How will you be contacting participants? *

If you plan to contact participants by email, how will you get your list of email addresses?

How many times will you contact the participants or send reminders?

How are you documenting consent? *
[Please see Georgia tech’s EU GDPR policy for more information: http://www.policylibrary.gatech.edu/legal/eu-general-data-protection-regulation-compliance-policy]

Attach your Informed Consent Form here:

If you have IRB approval, please attach your approval letter here:

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