SCCM Survey Application

SCCM Survey Application

The Society of Critical Care Medicine (SCCM) offers a service to disseminate research surveys for individuals or institutions. Surveys are reviewed by the SCCM Scientific Review Committee. Please visit sccm.org/researchsurveys to review prerequisites and submission requirements before completing this form. Once you have reviewed the submission requirements, complete this form to request a review of your survey project.
Survey author’s name and credentials
Contact Email
Are you currently a SCCM member?
Is this survey an SCCM task force or SCCM committee project?
Please provide the name of the SCCM task force or SCCM committee that is working on this survey.
Survey title
4. Date submitted

MonthDayYear
Date submitted

MonthDayYear
Date
5. Request send date for your survey.

MonthDayYear
Request send date for your survey. Please allow at least 6 weeks for review after submission.

MonthDayYear
Date
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).
Provide a letter of Institutional Review Board approval, exempt status, or "closed" status for this project.

Upload a File

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

Upload a File

Cancelof
Provide a message to be included in the email to SCCM members regarding your survey. Your message should be no more than 200 words, include why the audience should participate in the research, indicate how long the survey will take to complete, and include a sign-off from the principal investigator.
Provide the link to your survey.
Please choose which categories of SCCM members you would like this survey to be sent to. Please keep in mind that your survey should ideally be designed for a multiprofessional audience. You may choose more than one option.

Other
Specify Other Category
Please indicate if your survey is relevant to adult clinicians, pediatric clinicians, or both.
Remember that your survey should ideally be directed to a multiprofessional audience.
Upon approval, your survey will be sent twice via email to a targeted audience (once as an initial send and again as reminder within the same week). The dissemination fee is $3,000 for SCCM members and $4,000 for nonmembers.
Please provide any additional information regarding your survey.
By submitting this application, you agree to have SCCM distribute your survey to the requested audience. While SCCM ensures delivery to targeted recipients, it does not guarantee participation or response rates. Survey engagement may vary based on factors beyond SCCM’s control.
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