Section 1. User Information Your Classification * UNT Undergraduate StudentUNT Graduate StudentUNT Post Doc StudentUNT FacultyNot Affiliated with UNT Name * Email * Phone * UNT Department or Company * Name of UNT Advisor (if applicable) UNT Advisor's Email Are you filling this form out for yourself, or for someone else? * - Select -For MyselfFor Someone elseA UNT postdoctoral researcher may only request access to an instructional instrument if they will be using it for directly mentoring a UNT undergraduate or graduate student enrolled in laboratory credit hours. Name of the person you are requesting for Email of the person you are requesting for Section 2. Type of Service Requested Which instrument would you like to use? * Type and Model Are you requesting access to the instrument for instructional or research use? * Instructional Research Instructional Use Info Name of the instructor of record of the course Date & time the students are performing the experiment. Purpose & details of the experiment. Include what TA & students are doing specifically in regards to the experiment. What assistance do you need from laboratory staff? Any items/supplies need to be provided? If you are requesting training, what is your availability 1-2 weeks prior to the scheduled experiment date? Other Comments For which chemistry course(s) will you be needing access to this instrument? * - Select -CHEM 2900 - Introduction to Chemical ResearchCHEM 2910 - Introduction to Chemical ResearchCHEM 3210 - Organic Chemistry Laboratory ICHEM 3220 - Organic Chemistry Laboratory IICHEM 3230 - Physical Chemistry Laboratory ICHEM 3250 - Physical Chemistry Laboratory IICHEM 3452 - Quantitative Analysis LaboratoryCHEM 4351 - Forensic ChemistryCHEM 4620 - Advanced Inorganic Chemistry LaboratoryCHEM 4632 - Instrumental Analysis LaboratoryCHEM 4900 - Special ProblemsCHEM 4910 - Special ProblemsCHEM 4912 - Undergraduate Research CapstoneCHEM 4951 - Honors College Capstone ThesisCHEM 5900 - Special ProblemsCHEM 5910 - Special ProblemsCHEM 5920 - Research Problems in Lieu of ThesisCHEM 5930 - Research Problems in Lieu of ThesisCHEM 6900 - Special ProblemsCHEM 6910 - Special ProblemsCHEM 6940 - Individual ResearchNote: You should be currently enrolled in the course or teaching a lab course in order to use the instrument. There is an exception for research courses (4900, 5950, 6940 etc), where you may request access in the Summer before or after enrolling in the course. Are you requesting training? * - Select -Regular TrainingSample Testing ONLYNo Training neededSample Testing will ONLY be done by a lab supervisor Section 3. Training Which instrument are you requesting training on? Type and Model Which instrument training technique are you requesting? What information do you hope to obtain from this training? How familiar are you with this technique? Zero 1 2 3 4 5 On a scale from 0 (none) to 5 (very) Research Use Info What is the compound to be analyzed? List all relevant chemical & physical properties for analysis. What is the matrix? Is the sample safe for the instrument & of the proper technique to be used for analysis? How many samples (items) need to be analyzed? If you're requesting independent usage, how much time are you requesting access to the instrument (X h per day, X days needed, & X weeks for completion)? This aids in meeting scheduling needs for all requests. What information do you hope to obtain for this sample/expected information from analysis? Other Comments Terms and Conditions a. I will not use any instrument for any reason without prior approval by laboratory staff. I will only use instruments that I have been trained on and authorized to use by laboratory staff. I will request training on each instrument I want to use prior to using the instrument. I will get approval from laboratory staff for each new analysis method prior to using the instrument for said analysis. Each time I want to use any instrument, I will schedule usage time with laboratory staff prior to using or having access to any instrument. I will only have access to the instrument at the time which I reserved the instrument for. b. If I am a UNT undergraduate student, UNT graduate student or UNT post doc student, I must have advisor approval prior to submitting this usage request form and scheduling time on any instrument. I am aware that the faculty advisor must email laboratory staff to give approval for each request. I am aware that the faculty advisor may incur financial costs because of damages resulting from user negligence and the user will lose access to any instrument in the shared instrumentation labs. Examples of such negligence include, but are not limited to, mishandling or physically damaging instrument, moving or re-configuring components of the instrument, spilling liquids or other substances, using the instrument for any purpose other than that for which it was designed, and using an unauthorized method or using any instrument without laboratory staff approval. c. Violation of any of these terms and conditions herein or policies for the shared instrumentation labs will result in loss of access to any instrument in the shared instrumentation labs. Accept Terms and Conditions * I accept the Terms and Conditions listed above and will abide by them Submit
