Educational Survey Request Form
Thank you for your interest in surveying our medical students. The Pritzker School of Medicine wants to encourage scholarly and rigorous development of curricula and projects, but our students are surveyed numerous times throughout their years at Pritzker, we want to protect their time. We now ask that all individuals interested in surveying the students complete a request form that helps Pritzker better understand the reasons and need for such surveys.
Please complete the following online form. The Survey Review Committee will review your request, and you will be notified of their decision within four weeks.
Your answer to question Email must be a valid email address.
Your answer to question Phone Number must be a valid U.S. or Canadian Phone Number.
Please tell us about yourself:
Education Role (if any):
Are you currently involved in any of the following?
S&D Medical Education Track
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