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<apex:page standardController="Lead" extensions="LeadMassSendSurveyController" recordSetVar="leads">
    <apex:form>
        <apex:selectList value="{!selectedSurvey}">
            <apex:selectOptions value="{!surveys}"/>
        </apex:selectList>
    	<apex:inputField value="{!sendSurveyForm.SEO__Survey_Sent__c}"/>
        <apex:commandButton action="{!sendSurveys}" value="Send Surveys"/>
    </apex:form>
</apex:page>

public with sharing class LeadMassSendSurveyController 
{    
    private ApexPages.StandardSetController standardController;
    
    public SEO__Survey_Sent__c	sendSurveyForm	{get { sendSurveyForm = new SEO__Survey_Sent__c(); return sendSurveyForm; } set;}
    public String		selectedSurvey  {get; set;}
    
    public LeadMassSendSurveyController(ApexPages.StandardSetController standardController)
    {
        this.standardController = standardController;
        this.sendSurveyForm.SEO__Survey_Sent__c = Datetime.now();
    }
    
    // get a list of surveys for the form picklist
    public List<SelectOption> getSurveys() {
        List<SelectOption> surveys = new List<SelectOption>();
        for (SEO__CSEO_Survey__c s : [SELECT Id, Name FROM SEO__CSEO_Survey__c])
        {
            surveys.add(new SelectOption(s.Id , s.Name));
        }
        
        return surveys;
    }   
    
    public PageReference sendSurveys()
    {       
	List<Lead> selectedLeads = (List<Lead>) standardController.getSelected();
        System.debug(selectedLeads);
        System.debug(selectedSurvey);
        System.debug(sendSurveyForm.SEO__Survey_Sent__c);
        return standardController.cancel();   
    }
}