Frederick Seitz Materials Research Laboratory
Central Facilities

Facility Use Proposal Form for Academic Research
for users not affiliated with the University of Illinois

Title of Research Proposal:  
Funding Source: Please specify for any item with "Other":

If the U.S. government is the source of any of the funds paid by COMPANY under this agreement, then COMPANY represents the following 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.)
Proposal is: New     Change of Scope
If Change of Scope, please list current User Number :
Value of Testing Agreement: $   
Notices:
(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.)
Work to be performed by: Submitting users     FSMRL Facility staff
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. 


User: (Information on the researcher who will be performing the experiments.)
Title:
First Name:
Last Name:
Citizenship:
Employer/
Institution:
Enter the name of your institution below.
  
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 Mauro Sardela (Director of Facilities)
Mauro Sardela Steve Burdin CQ Chen Jeff Grau
Doug Jeffers Rick Haasch Jim Mabon Scott MacLaren
Lou Ann Miller Tao Shang Julio Soares Timothy Spila
Wacek Swiech Kathy Walsh Xiaoli Wang Lon Westfall
Honghui Zhou