To help respond to your request effectively, please fill out this checklist to the best of your knowledge of the research at this time. If some of the information is unknown, please leave the relevant section blank. Name of Principal Investigator Does the Principal Investigator work or study at the University of Waterloo? - Select -YesNo Please indicate the Principal Investigator's current role at the University of Waterloo - Select -FacultyStaffGraduate studentUndergraduate student Department of Principal Investigator Program of Principal Investigator Organization of Principal Investigator Email address of Principal Investigator Phone number of Principal Investigator Are there other Investigators involved with this research study? - Select -YesNo Please include any other investigators at UWaterloo or external to UWaterloo. Which statement best describes the affiliation of the other Investigators? - Select -ALL work or study at the University of WaterlooALL work or study at organizations other than the University of WaterlooSome are at the University of Waterloo and some are at organizations other than the University of Waterloo Name(s) and Organization(s)/Department(s) of other Investigators Name of study Expected study launch timing Expected study launch timing: Year Year2023202420252026 Expected study launch timing: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Description of research Is this request for a free hour consultation and/or survey review, or are you also interested in more of our services? - Select -Consultation and/or Survey Review onlyI am interested in additional services Are you interested in a consultation, survey review, or both? - Select -ConsultationSurvey ReviewConsultation and Survey Review Which additional services are you interested in? Survey Development (i.e., Research Design, Sample Design, Instrument Design, Field Pretesting) Survey Programming (Qualtrics or Voxco) Survey Data Collection Top-line Data Analysis Being considered for the Office of Research grant application partnership program Program Review Other, please specify... Which services are you interested in? Consultation Survey Development (i.e., Research Design, Sample Design, Instrument Design, Field Pretesting) Survey Programming (Qualtrics or Voxco) Survey Data Collection Top-line Data Analysis Program Review Other, please specify... Desired survey methodology Web survey Telephone survey Mail survey Face to face survey (local Waterloo region only) Not sure yet Please select all that apply. Estimated survey length in minutes % of open-ended questions Will all respondents be asked the same questions or will a portion be asked different questions? What respondent group do you want to target? Will you be supplying the target respondent contact list? Yes No Other, please specify... Enter other… What are the estimates of the prevalence of the target respondents within the target area? What qualifiers do you require for the target respondents? Do you require quotas for any of the qualifiers? Yes No Other, please specify... Enter other… What are the quotas? What is the desired number of respondents to complete the survey? How long do you want the web survey hosted online? Known timing/deadlines What is your estimated budget? Will you be providing incentives for the respondents to complete the survey? Yes No Other, please specify... Enter other… Do you require the Statistical Consulting and Survey Research Unit to purchase and/or distribute the incentives? Yes No Other, please specify... Enter other… In what language(s) will the survey be offered? English French Spanish Is translation required? - None -YesNo Are you applying for funding? Are you applying for funding? - None -I am applying for funding for this researchI have funding for this researchOther, please specify... Enter other… When is the funding application due? When is the funding application due?: Year Year2023202420252026 When is the funding application due?: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Name of grant When do you anticipate receiving funding? When do you anticipate receiving funding?: Year Year2023202420252026 When do you anticipate receiving funding?: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Do you consider yourself an early career or first-time research grant applicant? Please provide any other details or information you want to mention Please upload relevant documents here (i.e., abstract, grand application, draft questionaire, etc.) or please send as attachments to scsrusurveys@uwaterloo.ca with subject line: checklist attachments)One file only.100 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. How did you hear about the Statistical Consulting and Survey Research Unit? Colleague/peer Past client University of Waterloo website Online search Received a brochure Received a postcard Statistical consulting and Survey Research Unit newsletter University of Waterloo Office of Research University of Waterloo Institutional Analysis & Planning Saw a poster Social media Other, please specify... Enter other… Please select all that apply. Leave this field blank
To help respond to your request effectively, please fill out this checklist to the best of your knowledge of the research at this time. If some of the information is unknown, please leave the relevant section blank. Name of Principal Investigator Does the Principal Investigator work or study at the University of Waterloo? - Select -YesNo Please indicate the Principal Investigator's current role at the University of Waterloo - Select -FacultyStaffGraduate studentUndergraduate student Department of Principal Investigator Program of Principal Investigator Organization of Principal Investigator Email address of Principal Investigator Phone number of Principal Investigator Are there other Investigators involved with this research study? - Select -YesNo Please include any other investigators at UWaterloo or external to UWaterloo. Which statement best describes the affiliation of the other Investigators? - Select -ALL work or study at the University of WaterlooALL work or study at organizations other than the University of WaterlooSome are at the University of Waterloo and some are at organizations other than the University of Waterloo Name(s) and Organization(s)/Department(s) of other Investigators Name of study Expected study launch timing Expected study launch timing: Year Year2023202420252026 Expected study launch timing: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Description of research Is this request for a free hour consultation and/or survey review, or are you also interested in more of our services? - Select -Consultation and/or Survey Review onlyI am interested in additional services Are you interested in a consultation, survey review, or both? - Select -ConsultationSurvey ReviewConsultation and Survey Review Which additional services are you interested in? Survey Development (i.e., Research Design, Sample Design, Instrument Design, Field Pretesting) Survey Programming (Qualtrics or Voxco) Survey Data Collection Top-line Data Analysis Being considered for the Office of Research grant application partnership program Program Review Other, please specify... Which services are you interested in? Consultation Survey Development (i.e., Research Design, Sample Design, Instrument Design, Field Pretesting) Survey Programming (Qualtrics or Voxco) Survey Data Collection Top-line Data Analysis Program Review Other, please specify... Desired survey methodology Web survey Telephone survey Mail survey Face to face survey (local Waterloo region only) Not sure yet Please select all that apply. Estimated survey length in minutes % of open-ended questions Will all respondents be asked the same questions or will a portion be asked different questions? What respondent group do you want to target? Will you be supplying the target respondent contact list? Yes No Other, please specify... Enter other… What are the estimates of the prevalence of the target respondents within the target area? What qualifiers do you require for the target respondents? Do you require quotas for any of the qualifiers? Yes No Other, please specify... Enter other… What are the quotas? What is the desired number of respondents to complete the survey? How long do you want the web survey hosted online? Known timing/deadlines What is your estimated budget? Will you be providing incentives for the respondents to complete the survey? Yes No Other, please specify... Enter other… Do you require the Statistical Consulting and Survey Research Unit to purchase and/or distribute the incentives? Yes No Other, please specify... Enter other… In what language(s) will the survey be offered? English French Spanish Is translation required? - None -YesNo Are you applying for funding? Are you applying for funding? - None -I am applying for funding for this researchI have funding for this researchOther, please specify... Enter other… When is the funding application due? When is the funding application due?: Year Year2023202420252026 When is the funding application due?: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Name of grant When do you anticipate receiving funding? When do you anticipate receiving funding?: Year Year2023202420252026 When do you anticipate receiving funding?: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Do you consider yourself an early career or first-time research grant applicant? Please provide any other details or information you want to mention Please upload relevant documents here (i.e., abstract, grand application, draft questionaire, etc.) or please send as attachments to scsrusurveys@uwaterloo.ca with subject line: checklist attachments)One file only.100 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. How did you hear about the Statistical Consulting and Survey Research Unit? Colleague/peer Past client University of Waterloo website Online search Received a brochure Received a postcard Statistical consulting and Survey Research Unit newsletter University of Waterloo Office of Research University of Waterloo Institutional Analysis & Planning Saw a poster Social media Other, please specify... Enter other… Please select all that apply. Leave this field blank