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class="breadcrumb"><a href="/">Home</a> 禄 <a href="/about" title="CME Application, Policies, and General Information">CME/CE Tools & Resources</a></div> </div> </div> </div> </div> <div id="title-container"> <div id="title-container-inner" class="clearfix"> <h1 class="title" id="page-title">AAAAI Survey Request Form</h1> </div> </div> </div> <div id="page"> <div id="main-wrapper"> <div id="main"> <div id="content" class="column" role="main"> <a id="main-content"></a> <div id="content-area"> <article class="node-12242 node node-webform node-promoted view-mode-full clearfix" about="/content/aaaai-survey-request-form" typeof="sioc:Item foaf:Document"> <header> <span property="dc:title" content="AAAAI Survey Request Form" class="rdf-meta element-hidden"></span><span property="sioc:num_replies" content="0" datatype="xsd:integer" class="rdf-meta element-hidden"></span> </header> <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>The American Academy of Allergy, Asthma & Immunology (AAAAI) provides its individual members and constituent groups (including assemblies, interest sections, committees, subcommittees, workgroups, and task forces) the opportunity to collect data about its members and their practice of allergy/immunology. These surveys are distributed randomly to 20% of AAAAI membership. The data they generate are used for a variety of purposes, including the development of educational programming and as components of research initiatives. If you are conducting a survey to collect data for a work group report, you must submit a <a href="https://www.aaaai.org/Aaaai/media/Media-Library-PDFs/Allergist%20Resources/Statements%20and%20Practice%20Parameters/Intent-Form-Solensky-2024.pdf" target="_blank">work group report intent form</a> to be approved by the Practice, Diagnostics, and Therapeutics (PDT) committee first.</p><p>To submit a request to survey AAAAI members please complete this form. All survey requests are subject to the terms of the <a href="https://education.aaaai.org/sites/default/files/users/14/survey_data_ownership_policy_04.17.14.pdf">AAAAI Survey Data Ownership Policy</a>.</p></div></div></div><div class="field field-name-upload field-type-file field-label-hidden"><div class="field-items"><div class="field-item even"><table class="sticky-enabled"> <thead><tr><th>Attachment</th><th>Size</th> </tr></thead> <tbody> <tr class="odd"><td><span class="file"><img class="file-icon" alt="PDF icon" title="application/pdf" src="/modules/file/icons/application-pdf.png" /> <a href="https://education.aaaai.org/sites/default/files/survey_data_ownership_policy_04.17.14.pdf" type="application/pdf; length=101657" title="survey_data_ownership_policy_04.17.14.pdf">survey_data_ownership_policy_04.17.14.pdf</a></span></td><td>99.27 KB</td> </tr> </tbody> </table> </div></div></div><form class="webform-client-form webform-client-form-12242" action="/content/aaaai-survey-request-form" method="post" id="webform-client-form-12242" accept-charset="UTF-8"><div><div class="form-item webform-component webform-component-textfield webform-component--submitter-name form-item webform-component webform-component-textfield webform-component--submitter-name"> <div class="field-label"><label for="edit-submitted-submitter-name">Submitter Name</label> <span class="form-required" title="This field is required.">*</span></div> <input required="required" type="text" id="edit-submitted-submitter-name" name="submitted[submitter_name]" value="" size="60" maxlength="128" class="form-text required" /> </div> <div class="form-item webform-component webform-component-textfield webform-component--constituency-eg-aaaai-committee-other-organization form-item webform-component webform-component-textfield webform-component--constituency-eg-aaaai-committee-other-organization"> <div class="field-label"><label for="edit-submitted-constituency-eg-aaaai-committee-other-organization">Constituency (e.g. AAAAI Committee, Other Organization)</label> <span class="form-required" title="This field is required.">*</span></div> <input required="required" type="text" id="edit-submitted-constituency-eg-aaaai-committee-other-organization" name="submitted[constituency_eg_aaaai_committee_other_organization]" value="" size="60" maxlength="128" class="form-text required" /> </div> <div class="form-item webform-component webform-component-email webform-component--submitter-email form-item webform-component webform-component-email webform-component--submitter-email"> <div class="field-label"><label for="edit-submitted-submitter-email">Submitter Email</label> <span class="form-required" title="This field is required.">*</span></div> <input required="required" class="email form-text form-email required" type="email" id="edit-submitted-submitter-email" name="submitted[submitter_email]" size="60" /> </div> <div class="form-item webform-component webform-component-radios webform-component--leadership-institute form-item webform-component webform-component-radios webform-component--leadership-institute" aria-describedby="edit-submitted-leadership-institute-description"> <div class="field-label"><label for="edit-submitted-leadership-institute">Leadership Institute</label> <span class="form-required" title="This field is required.">*</span></div> <div class="description" id="edit-submitted-leadership-institute-description">Is this a Leadership Institute project?</div> <div id="edit-submitted-leadership-institute" class="form-radios"><div class="form-item form-type-radio form-item-submitted-leadership-institute"> <input required="required" type="radio" id="edit-submitted-leadership-institute-1" name="submitted[leadership_institute]" value="Yes" class="form-radio" /> <div class="field-label"><label class="option" for="edit-submitted-leadership-institute-1">Yes</label> </div> </div> <div class="form-item form-type-radio form-item-submitted-leadership-institute"> <input required="required" type="radio" id="edit-submitted-leadership-institute-2" name="submitted[leadership_institute]" value="No" class="form-radio" /> <div class="field-label"><label class="option" for="edit-submitted-leadership-institute-2">No</label> </div> </div> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--survey-rationale form-item webform-component webform-component-textarea webform-component--survey-rationale" aria-describedby="edit-submitted-survey-rationale-description"> <div class="field-label"><label for="edit-submitted-survey-rationale">Survey Rationale</label> <span class="form-required" title="This field is required.">*</span></div> <div class="description" id="edit-submitted-survey-rationale-description">Describe the need to complete this survey project, including the questions you are trying to answer.</div> <div class="form-textarea-wrapper resizable"><textarea required="required" id="edit-submitted-survey-rationale" name="submitted[survey_rationale]" cols="60" rows="5" class="form-textarea required"></textarea></div> </div> <div class="form-item webform-component webform-component-checkboxes webform-component--intended-audience form-item webform-component webform-component-checkboxes webform-component--intended-audience" aria-describedby="edit-submitted-intended-audience-description"> <div class="field-label"><label for="edit-submitted-intended-audience">Intended Audience</label> <span class="form-required" title="This field is required.">*</span></div> <div class="description" id="edit-submitted-intended-audience-description">Identify which AAAAI member categories you intend to survey. Select all that apply.</div> <div id="edit-submitted-intended-audience" class="form-checkboxes"><div class="form-item form-type-checkbox form-item-submitted-intended-audience-1"> <input type="checkbox" id="edit-submitted-intended-audience-1" name="submitted[intended_audience][1]" value="1" class="form-checkbox" /> <div class="field-label"><label class="option" for="edit-submitted-intended-audience-1">US Physicians</label> </div> </div> <div class="form-item form-type-checkbox form-item-submitted-intended-audience-2"> <input type="checkbox" id="edit-submitted-intended-audience-2" name="submitted[intended_audience][2]" value="2" class="form-checkbox" /> <div class="field-label"><label class="option" for="edit-submitted-intended-audience-2">International Physicians</label> </div> </div> <div class="form-item form-type-checkbox form-item-submitted-intended-audience-3"> <input type="checkbox" id="edit-submitted-intended-audience-3" name="submitted[intended_audience][3]" value="3" class="form-checkbox" /> <div class="field-label"><label class="option" for="edit-submitted-intended-audience-3">Allied Health Providers</label> </div> </div> <div class="form-item form-type-checkbox form-item-submitted-intended-audience-4"> <input type="checkbox" id="edit-submitted-intended-audience-4" name="submitted[intended_audience][4]" value="4" class="form-checkbox" /> <div class="field-label"><label class="option" for="edit-submitted-intended-audience-4">US Fellows-in-Training</label> </div> </div> <div class="form-item form-type-checkbox form-item-submitted-intended-audience-5"> <input type="checkbox" id="edit-submitted-intended-audience-5" name="submitted[intended_audience][5]" value="5" class="form-checkbox" /> <div class="field-label"><label class="option" for="edit-submitted-intended-audience-5">International Fellows-in-Training</label> </div> </div> <div class="form-item form-type-checkbox form-item-submitted-intended-audience-6"> <input type="checkbox" id="edit-submitted-intended-audience-6" name="submitted[intended_audience][6]" value="6" class="form-checkbox" /> <div class="field-label"><label class="option" for="edit-submitted-intended-audience-6">Practicing Physicians Only</label> </div> </div> <div class="form-item form-type-checkbox form-item-submitted-intended-audience-7"> <input type="checkbox" id="edit-submitted-intended-audience-7" name="submitted[intended_audience][7]" value="7" class="form-checkbox" /> <div class="field-label"><label class="option" for="edit-submitted-intended-audience-7">Practicing and Retired Physicians</label> </div> </div> </div> </div> <div class="form-item webform-component webform-component-checkboxes webform-component--survey-data-distribution form-item webform-component webform-component-checkboxes webform-component--survey-data-distribution" aria-describedby="edit-submitted-survey-data-distribution-description"> <div class="field-label"><label for="edit-submitted-survey-data-distribution">Survey Data Distribution</label> <span class="form-required" title="This field is required.">*</span></div> <div class="description" id="edit-submitted-survey-data-distribution-description">Indicate how you plan to make use of the data you collect. Select all that apply.</div> <div id="edit-submitted-survey-data-distribution" class="form-checkboxes"><div class="form-item form-type-checkbox form-item-submitted-survey-data-distribution-1"> <input type="checkbox" id="edit-submitted-survey-data-distribution-1" name="submitted[survey_data_distribution][1]" value="1" class="form-checkbox" /> <div class="field-label"><label class="option" for="edit-submitted-survey-data-distribution-1">Develop educational programming, including annual meeting session proposals</label> </div> </div> <div class="form-item form-type-checkbox form-item-submitted-survey-data-distribution-2"> <input type="checkbox" id="edit-submitted-survey-data-distribution-2" name="submitted[survey_data_distribution][2]" value="2" class="form-checkbox" /> <div class="field-label"><label class="option" for="edit-submitted-survey-data-distribution-2">Write an abstract for submission to the AAAAI Annual Meeting</label> </div> </div> <div class="form-item form-type-checkbox form-item-submitted-survey-data-distribution-3"> <input type="checkbox" id="edit-submitted-survey-data-distribution-3" name="submitted[survey_data_distribution][3]" value="3" class="form-checkbox" /> <div class="field-label"><label class="option" for="edit-submitted-survey-data-distribution-3">Write a manuscript for submission to the JACI, JACI: In Practice, JACI: Global or other scientific journal</label> </div> </div> <div class="form-item form-type-checkbox form-item-submitted-survey-data-distribution-4"> <input type="checkbox" id="edit-submitted-survey-data-distribution-4" name="submitted[survey_data_distribution][4]" value="4" class="form-checkbox" /> <div class="field-label"><label class="option" for="edit-submitted-survey-data-distribution-4">Write a workgroup report as an official AAAAI document (see below)</label> </div> </div> <div class="form-item form-type-checkbox form-item-submitted-survey-data-distribution-5"> <input type="checkbox" id="edit-submitted-survey-data-distribution-5" name="submitted[survey_data_distribution][5]" value="5" class="form-checkbox" /> <div class="field-label"><label class="option" for="edit-submitted-survey-data-distribution-5">Other (Please email pdtreviews@aaaai.org with additional details)</label> </div> </div> </div> </div> <div class="form-item webform-component webform-component-radios webform-component--report-approval form-item webform-component webform-component-radios webform-component--report-approval" aria-describedby="edit-submitted-report-approval-description"> <div class="field-label"><label for="edit-submitted-report-approval">Report Approval</label> </div> <div class="description" id="edit-submitted-report-approval-description">If you intend to use the survey data to publish a workgroup report, position statement, or systematic review as an official AAAAI document, you must submit an intent form to be approved by the AAAAI Practice Diagnostics and Therapeutics (PDT) Committee first. When submitting the intent form to PDT for a survey intended to lead to a work group report, you will be asked to verify that the chair of your committee or other constituency group has approved the project.</div> <div id="edit-submitted-report-approval" class="form-radios"><div class="form-item form-type-radio form-item-submitted-report-approval"> <input type="radio" id="edit-submitted-report-approval-1" name="submitted[report_approval]" value="1" class="form-radio" /> <div class="field-label"><label class="option" for="edit-submitted-report-approval-1">Yes, this survey will support a work group report and all necessary approvals have been secured</label> </div> </div> <div class="form-item form-type-radio form-item-submitted-report-approval"> <input type="radio" id="edit-submitted-report-approval-2" name="submitted[report_approval]" value="2" class="form-radio" /> <div class="field-label"><label class="option" for="edit-submitted-report-approval-2">No, this survey will not support a work group report</label> </div> </div> </div> </div> <div class="form-item webform-component webform-component-radios webform-component--embargo-of-survey-data form-item webform-component webform-component-radios webform-component--embargo-of-survey-data" aria-describedby="edit-submitted-embargo-of-survey-data-description"> <div class="field-label"><label for="edit-submitted-embargo-of-survey-data">Embargo of Survey Data</label> </div> <div class="description" id="edit-submitted-embargo-of-survey-data-description">If you intend to publish the data you collect, you may request an embargo of up to one year in which to do so. During this time the AAAAI will not distribute the data you collect with any other individual or organization. Do you wish to request an embargo of your data to allow for publication?</div> <div id="edit-submitted-embargo-of-survey-data" class="form-radios"><div class="form-item form-type-radio form-item-submitted-embargo-of-survey-data"> <input type="radio" id="edit-submitted-embargo-of-survey-data-1" name="submitted[embargo_of_survey_data]" value="1" class="form-radio" /> <div class="field-label"><label class="option" for="edit-submitted-embargo-of-survey-data-1">Yes</label> </div> </div> <div class="form-item form-type-radio form-item-submitted-embargo-of-survey-data"> <input type="radio" id="edit-submitted-embargo-of-survey-data-2" name="submitted[embargo_of_survey_data]" value="2" class="form-radio" /> <div class="field-label"><label class="option" for="edit-submitted-embargo-of-survey-data-2">No</label> </div> </div> </div> </div> <div class="form-item webform-component webform-component-radios webform-component--acceptance-of-terms form-item webform-component webform-component-radios webform-component--acceptance-of-terms" aria-describedby="edit-submitted-acceptance-of-terms-description"> <div class="field-label"><label for="edit-submitted-acceptance-of-terms">Acceptance of Terms</label> <span class="form-required" title="This field is required.">*</span></div> <div class="description" id="edit-submitted-acceptance-of-terms-description">By clicking "Yes" you agree to the terms of the AAAAI Survey Data Ownership Policy, as attached above. Do you agree to the terms of the policy?</div> <div id="edit-submitted-acceptance-of-terms" class="form-radios"><div class="form-item form-type-radio form-item-submitted-acceptance-of-terms"> <input required="required" type="radio" id="edit-submitted-acceptance-of-terms-1" name="submitted[acceptance_of_terms]" value="1" class="form-radio" /> <div class="field-label"><label class="option" for="edit-submitted-acceptance-of-terms-1">Yes</label> </div> </div> <div class="form-item form-type-radio form-item-submitted-acceptance-of-terms"> <input required="required" type="radio" id="edit-submitted-acceptance-of-terms-2" name="submitted[acceptance_of_terms]" value="2" class="form-radio" /> <div class="field-label"><label class="option" for="edit-submitted-acceptance-of-terms-2">No</label> </div> </div> </div> </div> <input type="hidden" name="details[sid]" /> <input type="hidden" name="details[page_num]" value="1" /> <input type="hidden" name="details[page_count]" value="1" /> <input type="hidden" name="details[finished]" value="0" /> <input type="hidden" name="form_build_id" value="form-IEKieiaDs0x_DcyteCo62LggL4GdZKL4B_YOsg6sa38" /> <input type="hidden" name="form_id" value="webform_client_form_12242" /> <input type="hidden" name="honeypot_time" value="1732764793|gjZmSYA9G5fP2T1bw5uFzauDDLFPW5pr_H1iuEPDT_k" /> <div class="url-textfield"><div class="form-item form-type-textfield form-item-url"> <div class="field-label"><label for="edit-url">Leave this field blank</label> </div> <input autocomplete="off" type="text" id="edit-url" name="url" value="" size="20" maxlength="128" class="form-text" /> </div> </div><div class="form-actions"><input class="webform-submit button-primary form-submit" type="submit" name="op" value="Submit" /></div></div></form> </article> </div> </div> </div> </div> </div> <footer id="footer"> <div id="footer-inner" class="clearfix"> <p><span style="color:#555555; font-family:Verdana,arial,sans-serif; font-size:11px; line-height:16.5px">Medical content developed and reviewed by the leading experts in allergy, asthma and immunology.聽</span><br /><span style="color:#555555; font-family:Verdana,arial,sans-serif; font-size:11px; line-height:16.5px">漏 2023 American Academy of Allergy, Asthma & Immunology. 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