Information Request Details:  

* Mandatory

*Your Name

Work Phone

Email

Today's Date (MM/DD/YYYY)

Due Date  (MM/DD/YYYY)

Note: We will do all we possibly can to fulfill the request by due date you specify.  Please be considerate in avoiding urgency!

 Describe Request: Please be detailed: (e.g. Full time vs. Part time, semester(s) required, etc.)

Please note:  Anyone requesting assistance of the Office of Research and Planning in constructing a survey (Zoomerang):

• is responsible for providing the list of email addresses of all contacts

• is responsible for any (e.g. human subjects) permissions needed and clearance from the IRB

Are you requesting assistance with a survey from outside Brenau? Yes No   

     If "Yes,"  please continue.  If "No," please click "Submit" (below.)

Survey Specifics: 

Please provide any necessary information for connecting to survey, if appropriate.

Please provide any necessary information the office may need to log on:

Survey UserName

Survey Password