This Proposal is a new proposal (   ) or a Replacement for Proposal No._________.

This Proposal is for a single experiment (   ) or a Program (   ).

CHECK SUGGESTED REVIEW PANEL:

2. LIST OF COLLABORATORS (Underline Spokesperson)

Full Name (First, MI, Last)

Full Institution Address

Work Phone

Home Phone

E-mail

 

3. EXPERIMENTAL STATIONS REQUIRED (If 2 stations required, list both under first choice. Note number of shifts required on each station in section 4.)

First Choice:

Alternates:

 

4. ESTIMATED BEAM TIME REQUIRED IN 8-HOUR SHIFTS IN 1/2 YEAR BLOCKS

1st 6 Months

2nd 6 Months

3rd 6 Months

4th 6 Months

 

 
If your request goes beyond one year please explain why:

 
5. FOR EXPERIMENTS ON VACUUM BEAM LINES: LIST ALL SAMPLES YOU EXPECT TO INSERT INTO THE VACUUM SYSTEM AND ANY CONSTRUCTION MATERIALS AND COMPONENTS NOT GENERALLY CONSIDERED TO BE UHV MATERIALS OR COMPONENTS. Details must be given in proposal.
 

6. LIST ALL POTENTIAL HAZARDS including all toxic, radioactive, reactive, flammable materials, biohazards, infectious agents or hazardous procedures or equipment. Furnish detailed safety procedures in the proposal.

7. WILL HUMAN SUBJECTS OR LABORATORY ANIMALS BE USED? ____Yes ____ No
If yes, furnish details in the proposal. (If any proposed research involves the use of human subjects or laboratory animals, a research protocol must be submitted to Stanford University’s Panel on Human Subjects in Medical Research or the Panel on Laboratory Animal Care for review and approval prior to acceptance of the proposal. Investigations must comply with University regulations established by the Panels, federal legal standards, and the terms of the University’s Assurance filed with the Department of Health and Human Services.)

8. WHAT EQUIPMENT OR MATERIALS DO YOU EXPECT TO BE PROVIDED BY SSRL?

9. HAS A PROPOSAL COVERING THIS RESEARCH BEEN SUBMITTED TO OTHER SYNCHROTRON RADIATION FACILITIES, TO WHAT FACILITY? IF SO, ARE THERE PARTICULAR CAPABILITIES OF SSRL WHICH ARE REQUIRED FOR PORTIONS OF THIS RESEARCH?

10. PROPRIETARY RESEARCH:

____No Proprietary Research will be performed under this Proposal.

____Proprietary Research will be performed under this Proposal. (Note that proprietary research is subject to specific terms and conditions, and SSRL must be reimbursed at full cost recovery)
 
 
 
 
 
 

11. FOR DOE REPORTING PURPOSES, PLEASE CATEGORIZE YOUR PROPOSAL:

RESEARCH AREA (check all that apply)							FUNDING AGENCY (check all that apply)
	Biological and Life Sciences		Materials Science					DOE/BES		NSF
	Chemistry		Medical Applications					DOE/OBER		Industry
	Optics		Nuclear Physics					NIH		NASA
	Earth Sciences		Polymers					DOE: __________		USDA
	Engineering		Solid State Physics					DOD: __________		Foreign: _____
	Environmental Sciences		Other: ______________________					Other US Govt: ___________________
	Instrument Development		Other: ______________________					Other: ________________________

 
 

12. LIST THE NAMES AND ADDRESSES OF THREE PEOPLE WHO WOULD BE APPROPRIATE REVIEWERS FOR THIS PROPOSAL. (Please do not include people you have worked with or collaborated with during the last five years; forms without this information will be considered incomplete).

13. PLEASE GIVE A BRIEF ABSTRACT OF THE PROPOSAL: (There is a five-page limit to the body of the proposal.)

 
 

To be completed at SSRL This research is deemed to be of interest to the DOE and falls within the scope of the BES mission.
Signature, K. Hodgson, Director SSRL	Date:

October 1998
L. Dunn