Micro Imaging Laboratory - Usage Agreement

Instruction:

After completing the fields below, use the submit button to email the form to: sdmicroimaging@llu.edu

Note: If there is a second, or multiple projects, with different scope of work and grant funding, prepare a new form for each. It is the PI's responsibility to resubmit this form when there are any changes, in which case only name, date, study title and specific change are needed.

User Information

Date

PI Name

Department

Email

Phone

Project

Study Title

Assigned IRB/IACUC number:

Internal to LLUH:

External to LLUH:

Keywords

Department Contact

Phone

Email

Researchers authorized to plan and schedule experiments

1. (Last Name, First Name):

2. (Last Name, First Name):

3. (Last Name, First Name):

4. (Last Name, First Name):

Abstract/Summary: Please provide a abstract/summary similar in content to one submitted as the abstract/ summary for an NIH grant application. This information will stay confidential. We will use this information for evaluation your request for use the MicroCT Lab resources.

If you require consulting your typed name on the line below acknowledges that you agree to provide intellectual credit to your consultant when publishing your work and paying appropriate fees related to the work.