Request form

Submit your survey for Chapter review

Use this form to provide the information required for initial review. Submission does not guarantee approval or circulation. The Chapter will revert with approval, modification guidance or rejection reason after review.

Survey Request Details

Requester and survey information

Fields marked * are required.

Name *

Organization *

Designation

Requester type *

Email *

Phone / WhatsApp

Preferred package *

Preferred launch date

Survey title *

Survey objective *Recommended: 150–300 words.

Survey link

Expected completion time

Approx. number of questions

Preferred reminder date

Target audience *

Does the survey involve sensitive topics?

Academic ethics / IRB approval details

Additional notes

Declarations *

I confirm the survey is non-promotional and is not a disguised marketing, sales outreach or lead-generation campaign. I understand PMI Pune will not share member or volunteer contact data or personal identifiers. I agree that circulation is subject to Chapter review, approval, invoice and payment confirmation. I understand PMI Pune does not guarantee response volume, sample size or endorsement of findings.

This form submits to the included PHP handler. Update recipient email addresses in submit-survey-request.php before deploying to production. For Google Form/JotForm use, replace the form action with the approved Chapter form URL.