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  • Historic Courthouse - Bartow
  • Airboat Rides - Lake Wales
  • Highlands Reserve Golf Course - Davenport
  • Mulberry
  • Davidson Citrus Candy Factory - Dundee
  • Fantasy of Flight - Polk City
  • Fort Meade
  • Eagle Lake
  • Lake Morton - Lakeland
  • LEGOLAND Florida - Winter Haven
  • Eaglebrooke Golf Course - Lakeland
  • Southern Dunes Golf Course - Haines City
  • City Hall - Auburndale
  • Kissimmee State Park - Lake Wales
  • Lake Alfred
  • City Hall - Frostproof
  • Bok Tower Gardens - Lake Wales
  • Hillcrest Heights
  • Highland Park
  • Lake Hamilton

Custom Online Survey Request Form

Please complete the following form

  • First Name   Last Name
  • User ID:   Email Address:
  • Phone:   Division:
  • What is the purpose of the survey?
  • Dates must be in mm/dd/yy format.

    Desired Publish Date?   Desired Expiration Date?  
  • Is the survey to be taken anonymously?
  • Can the survey be taken by the same person more than once?
  • If your survey should be limited to a particular list of users, enter the semi-colon delimited list in the box below
    example: johndoe@polk-county.net;janedoe@polk-county;mikedoe@polk-county.net

Please create your survey draft in Microsoft Word and upload it here (only files with the extension of .doc, .docx or .pdf will be accepted).
For a sample draft survey click here.


NOTE

If your desired respondents do NOT have internet access, YOU will be responsible for distributing a paper version of the survey and then collecting and entering the data manually into the online survey builder.

Data Retention

Once the survey has expired, the survey data will be exported into an excel document for you to keep. Do not delete or lose this file as the survey data ; will only remain online for 30 days following expiration. After 30 days the data will be permanently removed from the online survey builder.


  • * Not responsible for translated content



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We enhance the quality of life for people throughout Polk County
Polk County Board of County Commissioners | 330 West Church Street | P.O. Box 9005 | Bartow, FL 33830 | 863.534.6000