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Research Survey Promotion Request

Before you submit your survey request, please keep the following in mind: 1. You MUST be a currently active Academy of Pelvic Health Physical Therapy Member 2. You MUST have your survey already created and posted via a form platform (i.e. Google Forms, JotForm, Survey Monkey). * For any surveys that need to be sent via e-mail to the Academy membership, please allow 3 weeks for processing. Upon receiving your request, your request will be reviewed by the Director overseeing your committee for approval and will then be sent to Academy staff for scheduling. Please, be open to any questions we may ask while we review your request. Should you have a question, please contact the Board Director to which your committee reports (if you are part of an Academy Committee). *Need help finding a survey platform? Check out: Google Forms, Survey Monkey, JotForm.

Select the circle below
Committee/Task Force/Group Name
Please select the group you are representing.
  • This is a Non-Academy sponsored research survey
  • I do not belong to an Academy committee/task force/SIG
  • CPG Task Force
e.g. University Name, Hospital Name, Research Institution Name
Your full name and credentials
Your email address
Please include URL link to your survey.
Rationale
Describe why this study is appropriate to advertise to the target audience?


Survey Description
If your survey is approved for promotion, we will use this survey description to promote it.


i.e. 10 minutes / how long it will take a respondent to complete the survey
Select Target Audience
  • Only Members (PTs, PTAs, SPTs)
  • PT Members Only (PTs)
  • PTA Assistant Members Only (PTAs)
  • SPT Members Only (SPTs)
  • Everyone - Members, Non-Members, Public
  • PT Members who have a PhD (PhDs)
  • PT Members who have earned the WCS (WCS)
  • Public - Individuals who do NOT have a medical background
  • Physicians
  • Acute Care Physical Therapists
  • Physical Therapists (PTs)
  • Physical Therapist Assistants (PTAs)
  • Student Physical Therapists (SPTs)
  • Non-physical therapist healthcare providers
Select Marketing Method(s)
  • Newsletter Mention
  • Dedicated Eblast
  • Website Listing
  • Social Media
When should we take down the survey from our website. We will also communicate this as the deadline for respondents to submit their responses.
IRB Approval Status
Comments
Anything else we should know?
  • {name}
Attachments
Please include any relevant attachments/files.
Attach file
Drop files here

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