Access Request Form Instructions Part 1: Project information Please fill out this section with your contact information and preliminary project. If persons other than the principal investigator (e.g., students or postdocs) will be travelling to our facilities, include them under “Other participants”. Part 2: Project description Please include the following elements: 1. An overall description of the work to be done and analytical methods needed, 2. A brief explanation of the experience level of the person(s) who will be visiting our facilities, both in terms of the proposed project, and the methods to be use at our site. Previous experience in using instrumentation is not necessary, but knowing your experience level will help us better schedule your visit. 3. Publication/dissemination plans, if applicable. The project description should be no longer than 2 pages, including figures and/or tables, and key references, if needed. Send the completed form to nce2ni@vt.edu Additional Information Applications are evaluated only for technical feasibility and safety, not technical merit—all legitimate users are welcome. In case of proprietary work, our laboratory staff only needs to know enough information about the materials to be analyzed in order to determine analytical compatibility and for safety and handling purposes. Part 1: Project Information Project Title: Principal Investigator: Position: Department: Institution: Address: Email: Other Participants: Name Phone: Position (title or role) Type(s) of instrumentation and facilities needed: [ ] Nanoparticle synthesis (laboratory bench/hood work) [ ] Assistance with sample preparation [ ] UV-Vis spectrophotometry (UV-Vis) [ ] Size distribution and zeta potential (DLS) [ ] Electron microscopy (TEM, SEM) [ ] Atomic force microscopy (AFM) [ ] Optical microscopy [ ] Ion lithography (FIB) [ ] Raman spectroscopy (AFM-Raman) [ ] Secondary Ion Mass Spectrometry (SIMS) [ ] Electron spectroscopy (XPS) [ ] Powder X-ray diffraction (XRD) [ ] Powder surface area (BET) [ ] Aerosol instrumentation [ ] Other(s):______________________ Affiliation Email address Type(s) of samples to be analyzed or synthesized [ ] Geological (mineral) [ ] Biological [ ] Synthetic nanoparticles (composition:_____________) [ ] Polymers [ ] Other:______________ Sample form: [ ] aerosol [ ] solid or powder [ ] liquid suspension [ ] embedded in complex matrix (e.g., soil, biological media) Special precautions*: [ ] Radioactive [ ] Pathogen (BSL level ________) [ ] Explosive [ ] Other known limitations ______________________ *VT EHS approval may be needed Part 2: Project description (limit 2 pages)