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CLIO
EXPERIMENTAL PROPOSAL 2012
Send back this form before December 15th 2011 preferably in pdf to:
Jean-Michel.Ortega@u-psud.fr and to accueil.clio@u-psud.fr
Title of the project : ...........................................................................................................................................
Is it a new project?
yes
no
If not, year, number and title of the last accepted proposal : ........................................................................
..............................................................................................................................................................................
Project leader
Family name : .................................................
First name : ....................................................................
Phone number : ...............................................
Fax : ................................................................................
e-mail : ................................................................................................................................................................
Complete name of laboratory : .........................................................................................................................
..............................................................................................................................................................................
Full address : ......................................................................................................................................................
Postal code : ........................................................................................................................................................
City : ................................................................
Country : ........................................................................
Institution :
CNRS
CEA
French Univ.
Foreign Univ.
Other
If « other » selected, specify the institution : ...................................................................................................
Beamline
Bio-AFMIR
Mass spectrometry with the FEL
Optical pump-probe
Nanostructures
SFG with the FEL
Other: …......................
Maximal and minimal wavelengths (mandatory) : ........................................................................................
Local contact:
A. DAZZI
P. MAITRE
D. SCUDERI
B. BUSSON
J-M. ORTEGA
Other : …......................
Number of requested days :
4
8
12
16
Other : ..............................
Unavailable periods : .........................................................................................................................................
Have you previously done an experiment with the CLIO FEL?
yes
no
If yes, in which year(s)? .....................................................................................................................................
Financial aid
Do you ask for any financial aid?
yes
no
Collaboration
Collaboration :
yes
no
Is this collaboration part of a contract?
yes
no
Name of the company : ......................................................................................................................................
If this project is supported by EC :
Type of contract : ........................................................................
Number : ...........................................
Validity of contract :
Starting:..........................................
Ending:...............................................
Partners
Partner n°1
Family name : .................................................
First name : ....................................................................
Phone number : ...............................................
Fax : ................................................................................
e-mail : ................................................................................................................................................................
Complete name of laboratory : .........................................................................................................................
..............................................................................................................................................................................
PhD Student :
yes
no
Date of end of thesis : ....................................................
Partner n°2
Family name : .................................................
First name : ....................................................................
Phone number : ...............................................
Fax : ................................................................................
e-mail : ................................................................................................................................................................
Complete name of laboratory : .........................................................................................................................
..............................................................................................................................................................................
PhD Student :
yes
no
Date of end of thesis : ....................................................
Partner n°3
Family name : .................................................
First name : ....................................................................
Phone number : ...............................................
Fax : ................................................................................
e-mail : ................................................................................................................................................................
Complete name of laboratory : .........................................................................................................................
..............................................................................................................................................................................
PhD Student :
yes
no
Date of end of thesis : ....................................................
Partner n°4
Family name : .................................................
First name : ....................................................................
Phone number : ...............................................
Fax : ................................................................................
e-mail : ................................................................................................................................................................
Complete name of laboratory : .........................................................................................................................
..............................................................................................................................................................................
PhD Student :
yes
no
Date of end of thesis : ....................................................
Partner n°5
Family name : .................................................
First name : ....................................................................
Phone number : ...............................................
Fax : ................................................................................
e-mail : ................................................................................................................................................................
Complete name of laboratory : .........................................................................................................................
..............................................................................................................................................................................
PhD Student :
yes
no
Date of end of thesis : ....................................................
In ................................................................
Date .............................................................
Signature of the project leader
DESCRIPTION OF THE PROPOSED EXPERIMENT
The proposal must not exceed 2 pages and must include: principle, aim, scientific interest of the experiment, justification for
the number of requested days and justification for using a Free Electron Laser, together with a bibliography allowing the
context of the experiment to be judged.
EXPERIMENTAL REPORT
Requested ONLY in case of previous experiment with the CLIO FEL
Program committee 2011 project number: ......................................................................................................
Title of the project : ...........................................................................................................................................
Beamline:
Bio-AFMIR
Nanostructures
Mass spectrometry with the FEL
SFG with the FEL
Optical pump-probe
Other: …........................
Number of used days: …..............................
Starting date: ….......................
Authors: …...........................................................................................................................................................
CHEMICALS FORM
Thanks to list the extra equipment that you will bring in the experimental room and all the chemicals that will be used
Equipment:
Describe the extra instruments you will bring from your laboratory, their security application and the safety measures you will
adopt for your experiment:
LASER or other optical source: …....................................................................................................................................................
Class : …................
Power/Energy : …............… Wavelength:..............................…..
Don't forget to bring your laser protection goggles if you bring your own laser to CLIO. Think to additional people.
Other equipment: …........................................................................................................... ................................................................
Chemicals:
Please note that chemistry experiments and stocks of chemicals are prohibited in the experimental rooms. If you want to prepare
samples, the chemlab CLIO (building 202) provides chemical preparation facilities for internal and external users; it is equipped with
standard chemical instrumentation.
Do you want an access to the chemistry laboratory?
Yes
No
List all the chemicals you will use:
Gas, cryogenics
If you want to use toxic, flammable, corrosive gases, please note that B0 and B1 gas cylinders only are allowed in the experimental
rooms.
Product name or molecular formula
ex.: CO
Quantity
ex.: B20
For not indexed chemicals (noncommercial products, no MSDS available): give toxicological information available and the risks
identified. For standard chemicals, join the Material Safety Data Sheets – mandatory.
Liquids, solids
C.A.S. Number
Product name and molecular formula
Quantity