NCMIR User Application

The NCMIR User Application is composed of two parts (where each part has two sections):
Part One - User Information and Project Description/Resource Request.
Part Two - Funding Sources and References.

(Any field with a red asterisk * denotes a required field)

Section 1: User Information

Application

First Name *		Last Name *
Email *		Phone *
Fax *		Degree *
Title *		Other Title

Principal Investigator (Please enter data if P.I. is NOT applicant*)

Applicant is the PI. No additional information is required.
First Name		Last Name
Email		Phone
Fax		Degree
Title		Other Title

Laboratory Information

Institution
Department
Organization/Lab
Major Research Area
Address Line 1
Address Line 2
City
State
Province
Postal code
Country

Section 2: Project Description/Resource Request

Project Status

Select Project Status *

Continuing New

Title and Keywords

Title *
Keywords *

Abstract/Summary

Abstract: * Please provide a brief abstract (3-5 sentences) similar in content to one submitted as the abstract for an NIH grant application. Once your project is approved this abstract will be included as part of the NCMIR annual report to NIH and will be available on the publicly accessible CRISP NIH database. *

Full Summary: * In this second box, please provide a more detailed description of the project(s)/experiment(s) you wish to carry out with NCMIR resources. For this summary, you can provide us with information you do not wish to have disclosed. This information will stay confidential. We will use both the non-confidential and confidential materials in evaluating your request for use of NCMIR resources. *

Resources Requested (Select AT least one.) *

Advanced microscopies
Software
Computational resources	Specify computer platform(s)
Experimental protocol/reagents	Specify reagent type(s)
Internet connectivity	Broadband DSL Dial-up

Project Personnel

Will you be providing personnel? *	Yes No
First Name
Last Name
Title
Other Title
Email
Degree

Visits

How many times do you anticipate to visit NCMIR? *

Visits per

Next: Part 2 - Funding and References

Note - Please verify that all required fields are filled out before continuing to Part 2 - Funding and References.