X-Rad320 Service Request Form | Advanced Light Microscopy Facility

Advanced Light Microscopy Facility X-Rad320 Service Request Form

This form must be filled out by PIs to request usage of the X-Rad320 Instrument for members of their lab.

Requesting PI Name(Required)

Only PIs can request access for users

First Last

Requesting PI Email(Required)

Name of X-Rad320 user(Required)

First Last

User Email(Required)

User NetID username(Required)

User Status(Required)

If status is "Other," please specify

Department(Required)

Length of time user will need access to the instrument(Required)

KFS account # for billing(Required)

Type of service requested(Required)

Assisted sessions are appropriate when the need for imaging is limited or infrequent. Training is reserved for researchers who have samples prepared and are ready to use an instrument regularly. For X-Rad research involving animals, Assisted use is not available.

Sample Description(Required)

Provide a brief description of the sample to be irradiated.

Will the work involve animals?(Required)

Yes

Approved IACUC Protocol #(Required)

Enter the # of the approved IACUC protocol covering the research to be performed on the X-Rad320.

IACUC Expiration Date(Required)

IBC Registration #(Required)

Enter the # of the EHS approved IBC registration covering the reseach to be perfomed on the X-Rad320.

IBC Registration Expiration Date(Required)

Will the work require the Optimax Imaging Module?(Required)

Yes

PI Certification(Required)

By typing my initials in the line below, I certify that I am the X-Rad320 users' PI and the research to be performed is covered under an active EHS IBC registration and IACUC protocol (if applicable)

URL

This field is for validation purposes and should be left unchanged.