National Citizen Survey
ENROLLMENT FORM
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Thê N~tional Citizen' Survey'.
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The NCS'.BásieService.:......:,........,.::........::........;:..:.:;..............:.:..,."......;,.....:.:.........;.õ....:.":"'-""":'::"':"""""':,:,,'
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- Your selection of additiohal,optionswillbe confir:medduring the preparation for yourêommunity's citizen survey. At that ;tIme, you will
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pay half ~he,cost of theàddif,òrîa( optionsyoOHaveChosen. ,.YOU will be irîVoi~ècj f?r the balánce'for Basic Seríiiceand your.chosen '
'oPtioh~ afièr the survey Þrocessis complEited' and a fin~1 réport jsdeliveredtò' You: " , "
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Additiðnal optio,ns ~vailabie:'
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$800;00'
$800.00
'$l,OOO.CJo, ,
$0." ,
, $1~700.00
$6;00CWO'
, $1;400.00
'$1;2EtO~Op
$6,000.00
, ,$2,300.00
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.. 195.646 '
ICMA Member Number,
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Name,
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CITY'MANAGEl(
CITY OF SALINA-
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SaH.na, 1(S
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674.02:-.0736 '
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3.09"::57.0.0
(78:5)
Fax
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, ,jason¡;gage@salina~~rg "
E-mail
Phone
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2.paymf!ntMeth~d:~Che.ck Émclosed f~r $4;10(j.OO ,
3'~ 1'0 Order:,UsethèenclosÈÙ'J.busîríèss reply enVélop'e to '
send th is Cornplèt~d form with payment to:
The National Citiiensurvey~
National Resëàrch Center I nc,
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Attn: Heather Callahan Locke
300530th Street
Boulder CO 80301
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corifi,i1n¡¡¡ti~ri'& Caneellatiort PoJiey , .
YoU will receive wri~en, còn~rmé!tionof your order from National
'Research t~nter (NRè)within 10. days of, receipt öfpaYl11ent. Through
week 5 (seê Timeline,for The Nationat Citizen Survey~ (The NCS'"J), ,
jurisdictions may withdraw from The NCS'" and receive a full refund
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of fees paid, less2~%. After week 5,there will be no refunds:-
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05-056 REV.8/04
MKT #828955
tizen SurveyTM
CITY .oF SALINA
Jurisdiction Name
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Invoice
~e of add-on Option
No additional services No additional services are provided
"-Õpti~~-A~'-Surv;y"~¡~~ a';~-ilab¡; ñ-A~pãffig~~Ph-ïñšp';~iš¡;~ppe~'ffi~Tthe end of the survey, explaining the survey and
Spanish inviting the respondent to contact a member of your jurisdiction's staff by phone to
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Option B: Mail out 3,000 surveys Responses should number between 600 and 1,500. SamDle Size jlllarclin of Error $6,000
(insteod of 1,200) to 0 ,"odom somple Note the ",robonship between sompte size (nom be, , 100 10% r ~
of returned surveys) and margin of error in the box! 400 5%: i=
t . ht 600 4%! u
a rig . 1,000 3%! :J
1,500 2Yz% r ¡g
-õp'ì¡-;)ñ-c-:Phõñ;-dã.i~ collection --~-ÑëSwill be conductedb-y-PiïõñëWith4o0 completed interviews.Ñ7surveys Wi¡¡--'-.'$6,OÕO----¡:;;:--'
be mailed out. ;f
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Oplioo D, C",tom oonno lio ,dditlon lodod" a ,et of '"'tomlzed oonn, from rommoo",e, ,eleoted by yo", jon'dlotioo $1,000 1 olio
to the standard normative from our national database in addition to the standard normative comparisons. , u
comparisons) Custom norms will be provided alongside normative comparisons in mport tables. ~
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Option E: One open-ended question Responses will be categorized and reported in a table under separate cover, $1,250 <i
accom anied b a com lete list of verbatim res onses. ;¡;
Opt;oo F, Compariso", of up to th.., PI..., .", compi,t, 'u",., ..ports .om up to th... (3) pmv;ous adm;oi""'t;oos $1,700 DC OJ
","vious yea",' se""oa evaluation e/the, with thi, p"ket oe unde, sopacate rove" In oed., to meat tha sohadula, wa $0 toe ,"paat "
ratings! in your jurisdiction must receive these reports by the end of Week 5 in your timeline. If you are a repeat NCS ;:::
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Option G: Demographic Crosstabs will be provided in a separate report for 4 demographic questions by the $800 Q.
crosstabulations of data first 15 questions on the survey. """A representative will be in touch to help you select 8ÔQ
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Option H: Geographic Crosstabs will be provided in a separate report for one set of geographic identifying $800 ilJ
crosstabulations of data data by the first 15 questions. In most cases on policy question is used for citizens to 8~Q
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Option I: On-site presentation of Senior NRC staff will present survey results with staff, Council, Board8 or other $2,300
results' appropriate groups. Cost does not include travel expenses.
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Option K: Pavment via credit card Visa, MasterCard, Discover and American Exoress are accepted. $400
Descriotion
Price
Added Cost
$0
$1,405
$I ,400
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"""Please submit payment with the worksheets so that we ean start The NCSTM for you. Delays in payment will delay your survey project. """
Fax or send packet of completed worksheets to:
National Research Center, Inc., 3005 30th Street Boulder, CO 80301
Fax (303) 444-1145 . Phone (303) 444-7863
Contact: Heather@n-r-c.com
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