Access form for the CERM/CIRMMP EPR instrumentation
Fields marked with
*
are required
Project
*
Title of Project
Please enter the project title.
*
Principal Applicant
*
First Name
Please enter the principal applicant first name.
*
Last Name
Please enter the principal applicant last name.
*
Nationality
Please enter the principal applicant nationality.
*
Institution
Please enter the principal applicant institution.
*
Phone Number
Please enter the principal applicant phone number.
*
Email
Please enter the principal applicant email address.
Remember to also fill out the Visiting Scientist section below
*
Visiting Scientist
Flag if the Applicant and Visiting scientist are the same person.
*
First Name
Please enter the visiting scientist first name.
*
Last Name
Please enter the visiting scientist last name.
*
Nationality
Please enter the visiting scientist nationality.
*
Institution
Please enter the visiting scientist institution.
*
Phone Number
Please enter the visiting scientist phone number.
*
Email
Please enter the visiting scientist email address.
Project Proposal
*
Project goals, background information and time planning (max 2500 chars)
Please enter the project goals....
*
Project status (results, related pubblications, grant applications) (max 2500 chars)
Please enter the project status.
*
Expected results (max 2500 chars)
Please enter the expected results.
Additional information (Document format accepted: pdf, doc, docx, odt - max size 5MB)
*
Sample State
Solid
Liquid
Select the sample state.
*
Number of Samples
--- Select number of samples ---
1
2
3
4
5
6
7
8
9
Select number of samples
*
Instrument requested
X-Band
Q-Band
Select the instrument.
*
Experiment requested
DEER
High Score
Eseem
Select the experiment.
- Continuous Wave EPR at:
Room Temperature
Low Temperature
Select the temperature.
Collaborative Project
Is this a collaborative project with the CERM/CIRMMP ?
NO
YES
Potential Hazard
What are the potential hazards associated with the sample or the experiments?
Warning Requested
Minimum advance warning requested before measurement period
*
AntiSpam
67 + 35 =
Please enter the result of the sum.
Submit Request