Materials Research Laboratory - Grainger College of Engineering
Central Research Facilities

Facility Use Proposal Form for Industrial Use

Title of Research Proposal:
Company Name:

A signed TTA or FUA must be on file before work can be started. Once your proposal submission is complete, the appropriate forms will be mailed to the Primary User for signatures.
Statement of Work:
(i.e. what work will the MRL perform)
Work to be performed by:  Company employee  MRL facility staff
Will a Non-Disclosure Agreement be required?  Yes  No
May the University publish test results to third parties orally and in writing after a prescribed review period by the Company?  Yes  No
Value of Testing Agreement: $  $10,000 is the minimum value for agreements. You will only be charged for the actual value of usage in the facilities. Usage over the contracted amount requires a signed ammendment to the agreement.
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 or Other (You will be asked to attach pertinent information.)
(Address to which all notices pertaining to the agreement should be sent.)

(Street address required for courier delivery. An email address can be added for electronic communication.)

Proposal Information:

Proposal is: New     Change of Scope
If Change of Scope, please list current 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
1. About Your Investigators
Primary User:
First Name:
Last Name:
Work Address:
Work Phone:
Alternate / Home Phone: (optional)
MRL contacts or collaborators:
Check all that apply, at least one.

If unknown, check Mauro Sardela (Director of Facilities)
Mauro Sardela Mohammad Ali CQ Chen Kristen Flatt
Jeff Grau Doug Jeffers Rick Haasch Juan Lopez
MacDougall, Greg Lou Ann Miller Fubo Rao Roddel Remy
Tao Shang Julio Soares Jessica Spear Timothy Spila
Wacek Swiech Kathy Walsh Xiaoli Wang Zhiyu 'Jade' Wang
Lon Westfall Honghui Zhou