PALISI Network Survey Dissemination Request

All requests will be reviewed and approved by the Scientific Steering Committee. All follow-up communication will be addressed to the email given below.

After submitting your survey request you should be receiving an automated email confirmation of your request within 30 minutes. If you do not recieve a confirmation email, please reach out admin@palisi.org.

First Name

Last Name

Faculty Mentor (Trainees Only)

Copy of IRB protocol and IRB approval

Upload your file

Choose a file or drag and drop one here.

Survey Document (Maximum Completion Timeframe: 10 Minutes)

Upload your file

Choose a file or drag and drop one here.

Survey URL (Maximum Completion Timeframe: 10 Minutes)

Survey QR Code (if applicable)

Upload your file

Choose a file or drag and drop one here.

Target Population (Geographical Profile)

United States Only

North America

International

Target Population (Role Profile)

MD or Equivalent

Open to All

If approved by your IRB, would like PALISI to “tweet” out an invitation to participate on PALISI's X and BlueSky accounts?

Yes

If approved by your IRB, would you like us to include a link in the PALISI newsletter that is sent during the time your survey is active?

Yes

If approved by your IRB, would you like us to include a link on the PALISI website during the time your survey is active?

Yes

If approved by your IRB, would you like us to include a QR code to survey link on slides that will be displayed between presentations at the next main PALISI meeting?

Yes

Email Invitation Draft

Your email invitation draft should be written as a cover letter from you to those taking the survey. This should include a general description of the subject of the survey, how long the survey will take, whether it is anonymous, what the target population is, and whether the survey can be shared or tweeted. You may also want to give your contact information in case they have any questions.

Email Invitation Draft

Upload your file

Choose a file or drag and drop one here.

Other Documents

Upload your file

Choose a file or drag and drop one here.

Other Documents

Upload your file

Choose a file or drag and drop one here.

Other Documents

Upload your file

Choose a file or drag and drop one here.

Other Documents

Upload your file

Choose a file or drag and drop one here.

Other Documents

Upload your file

Choose a file or drag and drop one here.

PALISI Network Survey Dissemination Request

All requests will be reviewed and approved by the Scientific Steering Committee. All follow-up communication will be addressed to the email given below.

Faculty Mentor (Trainees Only)

Copy of IRB protocol and IRB approval

Upload your file

Choose a file or drag and drop one here.

Survey Document (Maximum Completion Timeframe: 10 Minutes)

Upload your file

Choose a file or drag and drop one here.

Survey URL (Maximum Completion Timeframe: 10 Minutes)

Survey QR Code (if applicable)

Upload your file

Choose a file or drag and drop one here.

Target Population (Geographical Profile)

United States Only

North America

International

Target Population (Role Profile)

MD or Equivalent

Open to All

If approved by your IRB, would like PALISI to “tweet” out an invitation to participate on PALISI's X and BlueSky accounts?

Yes

If approved by your IRB, would you like us to include a link in the PALISI newsletter that is sent during the time your survey is active?

Yes

If approved by your IRB, would you like us to include a link on the PALISI website during the time your survey is active?

Yes

If approved by your IRB, would you like us to include a QR code to survey link on slides that will be displayed between presentations at the next main PALISI meeting?

Yes

Email Invitation Draft

Upload your file

Choose a file or drag and drop one here.

Other Documents

Upload your file

Choose a file or drag and drop one here.

Other Documents

Upload your file

Choose a file or drag and drop one here.

Other Documents

Upload your file

Choose a file or drag and drop one here.

Other Documents

Upload your file

Choose a file or drag and drop one here.

Other Documents

Upload your file

Choose a file or drag and drop one here.