Request for Training

*** Training is free for all on-campus users. Project code is needed below for instrument usage only. ***

Name (print): ________________________________

E-mail: ____________________________

Lab Phone extension: ____________ Other Phone # if appropriate: ____________________

Date: ______________________________

Supervisor: __________________________________

Account #: __________________________________ (Chem project code)

Status (check one):

___ Undergraduate Student ___ Graduate Student

___ Exchange student ___ Visiting Scholar

___ Postdoc ___ Faculty/Staff

___ Other (Organization/Company Name: ____________________________________________)

Prior experience with NMR Spectrometer

___ None ___ Some ___A lot

Spectrometer used previously if applicable

___ Varian ___ Bruker ___ Others

Expected frequency of spectrometer usage

___ At least once a week

___ Once every month

___ Once every few months or longer

Faculty Approval:

Signature: ___________________________________

Date: ______________________________