Request to Disseminate Survey/Information by Individual or Organization
MSNO organization's mission is to promote and advance quality school health services throughout the Commonwealth and to promote the rights, interests and professional growth of our members.
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Your Name *
Contact person/organization email address *
Title of study/project/information *
Name of person's affiliated organization *
Date of Request *
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Is the organization a non-profit? *
What is the organization's mission? *
Is the organization's mission aligned with MSNO's mission? *
Is the person requesting for graduate (nursing) studies? *
Has the study/project been approved by the organization's IRB? *
If you answered Yes to previous question, please provide IRB approval # and organizations
Is the person requesting to promote their own organization's programs and services? *
Has the person requesting survey/info distribution an MSNO member (not required)? *
How would disseminating survey/information benefit MSNO members? *
Will requester agree to acknowledge MSNO in publications from study? *
Requester is asking for distribution of information via (check all that apply): *
Required
If you responded 'Other' to previous question, please explain: *
Sample of brief description of request to be considered for inclusion in MSNO communications (no more than 3-4 sentences, including contact information for person requesting): *
Thank you for your request.
MSNO is a non-profit organization managed by an all volunteer board. Your request will be reviewed by the MSNO Executive Committee and a response will be provided as soon as time allows. Thank you for your patience.  
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