FSMRL Central Facilities
Facility Use Proposal Form for Academic Research (U of I Investigators)

Title of Research Proposal:
Funding Source: Please specify for any item with "Other":
Account Number:
 		 Chart  -  Funding  -  Organization  - Program  -  Activity(if specified)
- - - -  

An account number is REQUIRED for all U of I users.
(This is the account that will be billed for all usage.)
Please remember to include an activity code (subproject number) if there is one!
If you do not include your account number, your proposal will not be processed!

Proposal is: New     Change of Scope   If Applicable, Current Facilities User Number:
Subject of Proposal
(Check all that apply)		   Materials Science Physics Chemistry
Polymers Medical Applications Biological & Life Sciences
Earth Sciences Environmental Sciences Optics
Engineering Instrument / Technique
      Development		 Other
1. About Your Investigators
Select the
Principal Investigator:
 		 Students and Post-Docs: This is your faculty advisor, please select from pull down if listed.

If you PI is not in the pull down list: Select New Principal Investigator and the next page (form) will be for entering your PI's information. 

    Please check if PI is intending to perform "hands-on" research at the FSMRL facilities,  i.e. , need their own user ID for this project
User:
Title:
First Name:
Last Name:
Citizenship:
Employer/
Department:
 
Status:
Work Address:
Work Phone:
Email:
FAX: (optional)
Alternate Phone: (cell / lab)
(optional)
FSMRL contacts or collaborators: Check all that apply, at least one. If unknown, check Ivan Petrov. Ivan Petrov (Director) Tony Banks Bharat Sankaran Steve Burdin
Rick Haasch Doug Jeffers Changhui Lei Jim Mabon
Scott MacLaren Mike Marshall Vania Petrova Ernie Sammann
Mauro Sardela Julio Soares Tim Spila Wacek Swiech
Jianguo Wen