When you hit the submit button, a copy of this information will be automatically sent to you for verification. Enter the FULL email address where you would like this information to be sent (do NOT enter "as below" or use an alias ):
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| User Information |
| Principal Investigator: |
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| Email address: |
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Site Responsible Investigator
( if same as PI, enter "PI" ): |
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| Email address: |
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| Project Information |
| Scanner Account (3 letters): |
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Changes to authorized user list (if any) |
Delete the following users: |
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| Add the following users: |
(Include nmr email address. if they do not have an nmr email address, you must apply for one here. ) |
| Current IRB/SRAC protocol number(s), title and protocol PI: |
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| Scanner Information |
| Scanner: |
1.5T
(Bay 2)
3T (Bays 3, 4, and 8, TRIO)
Trailer
7T
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3.0 T(16cm)
4.7T (33cm)
9.4T (21cm)
14T (8.9 cm vertical)
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MEG
EEG
MicroPET
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| Hours per week needed: |
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| Technologist support needed?: |
Yes
No |
| Will physiological monitors, INVIVO or AD instruments, AVOTECH headphones be used?: |
Yes
No
Note: projects using the physiological monitors, INVIVO or AD Instruments (in any bay) or the AVOTECH Headphones in Bay4 must submit their protocol to the GCRC. Please provide Karen Dervin with a copy of your GCRC approval letter. |
| Other requirements (specific Bay, etc.), account changes (fund number). or comments: |
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