MIL User Information Form

MICROSCOPY AND IMAGE-ANALYSIS LABORATORY USER INFORMATION FORM

Please provide the following information so that we can enter you in our user database. Once entered, this will allow you to log in and out of our system for instrument reservation. We will use this information for billing and messaging so all fields need to be filled out. You are responsible for the correct information as well as providing updated information as needed (ie new grants, change of chartfield data, changes of address, phones, etc.).

We do not provide “receipts” for user fees generated while using this facility or for labor. It is up to you to report this information to your PI or administrator.

**** Please make sure to check the box at the bottom of the form if you will need after hours access to the MIL facilities. ****

UNIQNAME:

UMID:

LAST NAME:

FIRST NAME:

E-MAIL:

DEPARTMENT:

BLDG./LAB ADDRESS:

PHONE NUMBER:

PRINCIPAL INVESTIGATOR:

PI Email:

PI Phone:

ADMINISTRATOR:

Admin Phone:

Admin Email:

CHARTFIELD DATA:

Fund:

Department ID:

Program:

Project Grant:

Sub-Class icr:

Shortcode:

Please tell us
what you need :
(training, new shortcode, etc.)


UNIQNAME:	UMID:
LAST NAME:
FIRST NAME:
E-MAIL:
DEPARTMENT:
BLDG./LAB ADDRESS:
PHONE NUMBER:

PRINCIPAL INVESTIGATOR:
PI Email:
PI Phone:
ADMINISTRATOR:
Admin Phone:
Admin Email:

CHARTFIELD DATA:
Fund:
Department ID:
Program:
Project Grant:
Sub-Class icr:
Shortcode:

Please tell us what you need : (training, new shortcode, etc.)