Access Request Form

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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 [email protected]
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)
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