SRO Inquiry Form

Survey Request Form

Client First Name: *
Client Last Name: *

Email: *

Phone:

Are you currently affiliated with the University of Michigan? *
YES NO

Are you interested in having SRC Survey Research Operations carry out data collection for your research?
YES NO Unsure

Project Title (if known):
(in 250 characters)

Briefly describe your research topic:
(in 250 characters)

What modes are you considering for data collection?

Web	In-person interview
Telephone or video interview	Mail
Focus Groups	Other: Specify:

Are you interested in having SRO collect any physical measures or bio-markers?
YES NO Unsure

What number of completed interviews or surveys do you hope to collect?

What is the population from which you plan to select your sample of respondents?

Enter the approximate date you plan to launch data collection.

About how long do you expect it will take for a respondent to complete your survey?
(Survey length in minutes)

Who do you expect to provide funding?

On what date do you expect to submit a proposal?

Is there any additional information we should know about the proposed study?

Are you the Principal Investigator for this research?
YES NO