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National Center for Microscopy and Imaging Research (NCMIR) Center for Research in
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Basic Science Building, Room 1000
University of California, San Diego
9500 Gilman Drive
Dept. Code 0608
La Jolla, CA 92093-0608 USA
Voice: (858) 534-0276
Fax: (858) 534-7497

NCMIR User Application

The application is composed of four sections:
User Information, Project Description/Resource Request, Funding Sources, and References.
( * denotes required fields.)

Section 1: User Information

Date:

Applicant
First name *		Last name *
Title *		Degree *
Phone *		E-mail *
Fax *

Principal Investigator
Applicant is the PI. No additional information is required. *(If this button is not selected, the following information is required.)

First name		Last name
Title		Degree
Phone		E-mail
Fax

Laboratory Information
Institution *
Department *
Organization/Lab *
Major Research Area *

Mailing Address *
Street 1 *
Street 2
City *
State	OR *	Zip *
Province		Country *


To Section 2: Project Description/Resource Request


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