Imaging Center - Training and Access Request
Please complete this form to be placed on the next training for in vivo imaging (PET, CT, bioluminescence and/or fluorescence).
- PET/CT training is currently on an individual basis as needed.
- Optical training is at the beginning of each month or when there are 10+ user requests, whichever comes first.
First name *
Your answer
Middle name
Your answer
Last name *
Your answer
UCLA ID (e.g. 111-111-111) *
Your answer
UCLA status *
Select all that apply.
Principal Investigator (PI): *
Your answer
UCLA Department *
e.g. Molecular & Medical Pharmacology
Your answer
Home Lab or Office Location *
e.g. CNSI 2112
Your answer
Contact e-mail: *
Your answer
Phone number or extension: *
Your answer
Do you have a CNSI ID card? If yes, what is the ID number? *
Your answer
TYPE OF TRAINING *
Select all that apply.
Required
Brief project title/description *
Your answer
Anticipated imaging start date *
MM
/
DD
/
YYYY
Questions or comments?
Your answer
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