Survey Management System
Survey Registration
Thank you for participating!!  Once you register your organization you will be asked to take the survey.  Please then refer as many of your colleagues to this site to also complete the survey.  If we have not already been in touch with you, we will contact you about gathering the feedback into actionable improvement plans!  Remember, all of the individual results will be maintained in strict confidence, we cannot identify individual participants.  But maximum participation by your organization will result in the greatest possible feedback.  (The BOLD fields are required information.)
 
Primary Contact Information This is person we should be contacting regarding your organization's results (presumably this is you!).  Remember, this information is NOT linked to the survey itself so your personal survey results will remain confidential.
First Name:
 This is the name of the Official Contact Person for this organization.
Middle Initial:
Last Name:
Title:
Organization Name:
 List the Organization as the name should appear on all reports.
Address:
City:
State:
Zip:
Telephone Number:
 Extension (if any):
Email Address:
 This should be the email address of the Official Contact Person - It will also be used as the password to login back in to this system to view your status and/or request a report.
Company Web Site:
 This is the website URL to which each user will be sent after they complete the survey.(do not include "http:\\")
Next, we need to know who you are, if you are not the person listed above.
Please enter your name:
Default survey (if applicable):
 If selected, all users will be sent directly to this survey. If not selected, they will be given the option to select from the surveys available to them (All Public surveys and any Private surveys assigned to the organization)
Referral Code (if applicable):
 This is the place to enter a Vendor Code for all authorized Vendors.
Organization Information (this is a standard survey, this will help us to compile the results and give you meaningful feedback)  Please answer these questions from the perspective of the organization listed above.  If you have a parent organization, answer only for your unit!
Yes No
Our organization operates to create a profit
Yes No
Our organization's primary purpose is to educate students
Yes No
Our organization's primary purpose is to provide health care or related services to patients
Yes No
Our organization is a governmental unit
How many Employees does your organization have? (If you have part-time employees, enter the total number.)
What is your approximate total annual operating budget? Very approximate!, we need this to know your size)
Enter ONLY numbers, no Characters or punctuation!
Division Codes (Optional): If provided, all users for this organization will be required to pick one of the Alphanumeric Codes provided here. If left blank, no Division code will be requested.
(Optional - If used, enter names separated by commas with no spaces or punctuation)
Segmentation Question (Optional): If left blank, no question will be asked. If specified, this question will be added to the question library and (if specified by the selected survey) will be used as an additional question. This is typically only used for organization specific demographic/segmentation questions.
(Optional - If used, enter only question with alphanumeric and spaces (no quotes or apostrophies)
Unique Org Code (Your organization's unique ID)
Enter letters and numbers only, no spaces or punctuation please!!


You may return to this page at anytime to update your information or to request a report.

 
If you have already completed the surveys, would you like to request a report?
Check to make sure your contact information above is correct, and click on the button below.

Request a Report