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Qualtrics Account Request

(Excludes the Smith School of Business; the School has a separate Qualtrics licence.)

** Mandatory fields are highlighted and preceded by an asterisk

Queen’s faculty, staff and graduate students can obtain a user account for Qualtrics by completing this form. Undergraduate students, including medical students, are not eligible for a personal account.

The form requires you to enter some basic information about yourself and your survey project. In particular, information about the population you are sampling, sample size and fieldwork dates allow us to offer scheduling advice and a sample distinct from all other samples to avoid fieldwork overlap and over-sampling. Where applicable, assurance of HSREB, GREB or unit-REB status must also be provided. Account authorization is undertaken by Institutional Research & Planning. Contact them directly if you have any questions or concerns about the account request procedure.

Survey Tool account owners acknowledge and agree that they will not conduct surveys that put Queen's in violation of FIPPA, PHIPA and/or PIPEDA, or collect other personal or confidential information without appropriate approval. More information about research ethics is found on the Office of Research Services Research Ethics page.

Contact Information

* (required for students)

Survey Information


Be sure to click the submit button only once. A separate Issue will be entered each time the button is clicked.

Click the SUBMIT button to send your request. You will receive an email confirmation when your request is successfully submitted; there is no need to reply to this email.