CTR Survey Set-up Request - Paper

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Please submit this form if your worksite will be conducting the CTR Survey by distributing paper forms to employees. After this form is submitted your CTR Representative will provide you with a supply of paper forms, marketing materials, and an Employer Identification sheet for submitting the completed forms for processing. Plan ahead and provide yourself with enough time for internal set-up and distribution. Please provide your CTR Representative at least two weeks to process your Survey set-up request.
Employer Information

Survey Population Information
Complete if a College or University
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