SSRL PROPOSAL FORM
For User Admin Use Only
Proposal No.
1.
____________
SSRL PROPOSALS ARE VALID FOR 2 YEARS AND ARE ELIGIBLE FOR RENEWAL Date Received ____________
FOR UP TO 2 ADDITIONAL YEARS BASED ON THE PRP’S REVIEW OF
SPOKESPERSON’S PROGRESS REPORT SUMMARIZING ACCOMPLISHMENTS TO DATE AND FUTURE
PLANS.
IF THIS PROPOSAL REPLACES AN EXISTING PROPOSAL, PLEASE PROVIDE OLD PROPOSAL NUMBER: _____
2. SUGGESTED REVIEW PANEL(S) (please select appropriate panel(s):
Structural Molecular Biology & Biophysics (BIO)
Molecular Environmental & Interface Science (MEIS)
Materials 1: Structure, Reactivity & Self-Assembly (MAT1)
Materials 2: Electronic Properties, Magnetic Properties & Surface Science (MAT2)
3. SPOKESPERSON and COLLABORATORS: (list spokesperson first)
Full Name
Institution & Mailing Address
Work Phone
E-mail Address Degree
4. TITLE:
5. BRIEF ABSTRACT (Please limit to 300 words/2000 characters):
6. POTENTIAL SAFETY CONCERNS OR HAZARDS. DESCRIBE DETAILED SAFETY ISSUES AND PROCEDURES IN
THE PROPOSAL TEXT.
CHEMICAL USE? ( ) NO ( )Yes
If yes, list Substance(s):_______________________________________________________________________________________
Common Name(s):___________________________________________________________________________________________
NANOSCALE MATERIALS USE? ( )No ( )Yes
- If yes, will there be open manipulation of nanoscale material samples at SSRL? ( )No ( )Yes
- If no, how are the samples contained? _____________
- If yes, a safety plan must be submitted to the SSRL Safety Office for approval. See CDC/NIOSH website for guidance.
http://www.cdc.gov/niosh/topics/nanotech/safenano/
BIOHAZARDOUS MATERIALS USE? ( )No ( )Yes
- If yes, what type __________ & what is the materials’ NIH classification _________________
HUMAN OR ANIMAL SUBJECT USE? ( )No ( )Yes
- If yes, what type __________. *Please contact SSRL Safety Office for further guidance.
Revised: February 2009
RADIOACTIVE MATERIALS USE? ( )No ( )Yes*
- If yes, what is the materials specific activity ________________________________________
*Radioactive substances may not be brought directly to SSRL. They must be shipped or taken to Operational Health Physics,
Bldg. 24, MS 84, 2575 Sand Hill Rd., Menlo Park, CA 94025; please contact Carol Morris at 650-926-3023 or Jim Allen at 650926-4064.
LASER USE? ( )No ( )Yes
- If yes, ANSI classification: ____________Wavelength: _________
Laser hazards controls you will apply:
Total power: __________
HAZARDOUS EQUIPMENT/ELECTRICAL EQUIPMENT? ( )No ( )Yes
- If yes, describe hazardous/electrical equipment you will be bringing to SSRL. Indicate if it is a commercial product, certified,
and if it has been altered in any way.
ELECTRICAL EQUIPMENT brought with you for use at SSRL must be certified by a Nationally Recognized Testing
Laboratory. If your equipment is not certified, please contact the SSRL Safety Office for guidance on obtaining certification
for your equipment under SLAC's Electrical Equipment Inspection Program (EEIP).
7. WILL PROPRIETARY/PRIVATE SECTOR RESEARCH BE PERFORMED?
No
Yes
(Note that Proprietary Research is subject to specific terms and conditions, and SSRL must be reimbursed in advance of
experiments at full cost recovery)
8. EXPERIMENTAL STATIONS REQUIRED:
(If two stations required, list both under first choice.)
First Choice(s)
Alternates
9. PROPOSALS ARE ELIGIBLE FOR BEAM TIME FOR 6 CONSECUTIVE SCHEDULING PERIODS. PLEASE
ESTIMATE BEAM TIME REQUIRED IN 8-HOUR SHIFTS IN EACH 3-MONTH SCHEDULING PERIOD:
1st 3 months
4th 3 months
2nd 3 months
5th 3 months
3rd 3 months
6th 3 months
10. FOR EXPERIMENTS ON UHV BEAM LINES, list all samples you expect to insert into the vacuum system and any
construction materials and components not generally considered UHV materials or components. Provide details in proposal.
11. SSRL EQUIPMENT OR MATERIALS REQUIRED:
12. REQUIRED FOR DOE REPORTING PURPOSES:
RESEARCH AREA (enter ‘ X’ in cell to left of all that apply)
Materials Science
Polymers
Earth Sciences
Engineering
Physics
Medical Applications
Environmental Sciences
Instrumentation or Other
Development
Chemistry
Biological and Life
Sciences
Optics
Purchase of Specialty
Services or Materials
Other: (specify)
Revised: February 2009
FUNDING AGENCY (enter ‘X’ in cell to left of all that apply)
DOE/BES
NASA
USDA
Fdn/Research Inst.
DOE/BER
NIH
Homeland Security
State/County/City
DOE Other: (specify)
NIST
Other US Gov’t: (specify)
Prof/Voluntary Assoc.
DoD: (specify)
NNSA
Industry
Foreign: (specify)
DVA
Other: (specify)
NSF
13. HAS A PROPOSAL COVERING THIS RESEARCH been submitted to other synchrotron radiation facilities? If so, which?
Are there particular capabilities of SSRL that are required for portions of this research?
14. HAVE YOU RECEIVED BEAM TIME AT SSRL IN THE PAST?
YES
NO
15. IF YOU HAVE PREVIOUSLY RECEIVED BEAM TIME AT SSRL, HAVE YOU NOTIFIED SSRL OF ALL OF YOUR
SSRL RELATED PUBLICATIONS, PATENTS AND/OR AWARDS?
YES
NO If not previously
reported, list below or append to this proposal information on publications, patents, and awards that resulted from your prior beam
time at SSRL (refer to lists at www-ssrl.slac.stanford.edu/pubs/):
16. IF YOU PUBLISHED RESULTS RELATED TO YOUR SSRL BEAM TIME, DID YOU ACKNOWLEDGE SSRL AND
FUNDING SOURCES IN THESE PUBLICATIONS?
YES
NO (If not already
done, please refer to instructions and sample acknowledgements at www-ssrl.slac.stanford.edu/pubs)
17. PEER REVIEW IS AN ESSENTIAL ELEMENT IN ENSURING THAT EXPERIMENTAL FACILITIES ARE
UTILIZED FOR THE HIGHEST QUALITY SCIENCE AND THAT THE ALLOCATION OF THIS SCARCE RESOURCE
IS FAIR AND TRANSPARENT. PROPOSAL SPOKESPERSONS ARE PERIODICALLY ASKED TO REVIEW
PROPOSALS RELATED TO THEIR AREA OF EXPERTISE. IF YOU WERE ASKED TO REVIEW A PROPOSAL
WITHIN THE LAST YEAR, HAVE YOU PROVIDED PEER REVIEW FOR SSRL PROPOSALS?
YES
NO
18. DO YOU HAVE ANY SUGGESTIONS OR CONCERNS WHICH YOU WOULD LIKE TO SHARE WITH SSRL, THE
PROPOSAL REVIEW PANEL, OR THE SSRL USERS' ORGANIZATION EXECUTIVE COMMITTEE?
Please send a list of up to 3 APPROPRIATE PROPOSAL REVIEWERS (Do not include people you have worked or collaborated
with during the last five years or SSRL staff members) and INAPPROPRIATE PROPOSAL REVIEWERS (List scientists whom
for reasons of conflict of interest should not review this proposal). List these names as a separate attachment or in the body of your
email message when you send this proposal. Please include name, institution and email address for appropriate reviewers. Name and
institution is sufficient for inappropriate reviewers.
Revised: February 2009