New User Form - UAB Institutional Research Core Program

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Preliminary Information

Internal/External(*)

Internal/UAB user

External/Non-UAB

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If UAB - Provide Full Acct# String to be Charged (must have an acct number prior to use)(*)

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Type of Usage(*)

Assisted

Unassisted

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Have you been trained to use this equipment? (You must be trained prior to unassisted usage) (*)

Yes

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Requestor Contact Information

Requester's First Name(*)

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Requester's email address(*)

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Requester's Title(*)

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Requester's Last Name(*)

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Phone number(*)

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Responsible Party

Name of PI or Responsible Party(*)

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Responsible Party’s Title(*)

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Responsible faculty (PI) member’s email address(*)

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Contact info for your Department's financial/business officer

Name(*)

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Phone Number(*)

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Email(*)

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If External to UAB, please provide a full billing address(*)

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Equipment and Usage Schedule

What facility are you requesting? (*)

Micro-Raman/Photoluminescence Spectroscopy

Microwave Plasma Chemical Vapor Deposition (CVD)

Panalytical Empyrean Multi-purpose X-ray diffractometer

XPS (all XPS usage is assisted)

XRD

SEM

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Description of Work to be Performed(*)

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If external to UAB, we will issue a quote so that you can request a purchase order from your organization. Please note that the date and time of usage on the quote will be an estimated date/time ONLY. We will need the PO prior to usage and will confirm date/time usage upon receipt. Initial below indicating that you understand that no work will be performed or time reserved for external entities without a P.O. Please initial below here:(*)

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