Materials Research Laboratory - Grainger College of Engineering
Central Research Facilities
Facility Use Proposal Form for companies part of the UIUC campus Enterprise Works

Companies that are not currently with Enterprise Works should fill the Industry proposal form instead.

Company Name:
Title of Research Proposal:

May the University publish test results to third parties orally and in writing after a prescribed review period by the Company?     Yes      No

If the U.S. government is the source of any of the funds paid by COMPANY under this agreement, then COMPANY represents the following Are Federal Funds being used for this project? Yes No
Percent of federal funds: % CFDA #:
Federal agency providing funds:
Are the funds subject to audit?  Yes  No
Audit standards: OMB Circular A-133 Other
(You will be asked to attach pertinent information for other standards.)

Proposal is: New     Change of Scope  
If Applicable, please provide your 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
Primary User: (Information on the researcher who will be performing the experiments.)
First Name:
Last Name:
Work Address:
Work Phone:
Email:
Net ID: Do not include @illinois.edu, @uiuc.edu, @uic.edu or @uis.edu. Leave blank if you do not have a NetID.
Alternate Phone: (cell / lab)
 (optional)
MRL contacts or collaborators:
Check all that apply, at least one.

If unknown, check Mauro Sardela (Director of Facilities)		 Mauro Sardela Mohammad Ali Rajen Basu CQ Chen
David Ehrhardt Kristen Flatt Rafael Silva Goncalves Sandeep Gorantla
Rick Haasch Mrinal Hota Ying He Toyanath Joshi
Peter Kurath Miao Liu Tiit Lukk Juan Lopez
Greg MacDougall Lou Ann Miller Roddel Remy Allison Sibert
Julio Soares Timothy Spila Pengcheng Sun Kathy Walsh
Xiaoli Wang Zhiyu 'Jade' Wang Lon Westfall Honghui Zhou