Survey Application

Please complete the following form to request a review of your survey project.

1. Survey Author Name and credentials

Contact Email:

Are you currently a SCCM member?

2. Is this survey a task force or committee project?

If yes, name of task force or committee

3. Survey Title

4. Date Submitted

MonthDayYear

5. Posting date that you are requesting for your survey

MonthDayYear

Remember to allow at least 6 weeks for review prior to this date.

6. Provide a summary of the research activity and rationale for conducting the study. State why you believe your survey is original, feasible, important, and relevant to ICU care. (add additional space as needed).

7. Provide a letter of IRB approval, exempt status, or "closed" status for this project.

Upload a File

8. Please attach an electronic copy (.doc or .pdf) of the actual survey tool

Upload a File

9. Provide the wording to be included in the direct mail or eNewsletter to the membership regarding your survey

10. Provide the link to your survey

11. Please indicate from the categories below the SCCM current members that you would like this survey to be directed to.

Specify Other Category

12. Please indicate audience

Remember that your survey should ideally be directed to a multi-professional target audience.

13. Upon approval, your survey will be sent via direct email to a target audience. The fee is $3,000 for SCCM members and $4,000 for nonmembers.

Additional Info