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Current CMCA user status
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Are you currently a registered user of CMCA facilities?
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Your details
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Title
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Given Name
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Family Name
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Affiliation
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University/Company
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School/Department/Section/etc.
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Faculty
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Contact details
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E-mail address
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Phone (daytime)
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Phone (after hours, optional)
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Phone (mobile, optional)
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MEDDENT network username (if applicable)
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UWA Staff/Student/Visitor Number
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Please provide details for someone we can contact in the event of an emergency
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Name of emergency contact person
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Phone number
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Their relationship to you
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Project information
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Status
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Expected project completion date (students & visitors only)
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Project category
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Project title
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Project description
Please upload a description of your research project as a text, Word or PDF file. This information will be used to help CMCA staff understand what training you will require to carry out your research. Please provide enough information to help us do this.
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Principle supervisor's details (students & visitors only)
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Title
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Given name
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Family name
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E-mail address
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Which CMCA laboratory will you mainly use?
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Please indicate whether you will mainly use the Crawley or QEII laboratory (or both)
Select all that apply
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Which CMCA facilities do you expect to use during your project?
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Select all that you expect to use
Note: You will be required to complete the appropriate training courses before you can use the instruments
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FOR and SEO codes
Please enter the most appropriate codes for your project. A description of the codes is available at http://www.research.uwa.edu.au/welcome/research_services/research_grants/preparing_an_application |
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Fields of Research (FOR) code
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Socio-Economic Objectives (SEO) code
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Risk assessment for samples/reagents that will be brought into CMCA
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Please provide a general sample description (max 300 characters)
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Where will samples be prepared?
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Is this a PC2/PC3 laboratory?
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If yes, OGTR number must be given here
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Sample form
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Sample concentration (if applicable)
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Are the samples hazardous?
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If yes, please provide details here
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Are the samples classified as dangerous goods?
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If yes, please provide details here
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Are the samples registered as part of a GMO project?
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If yes, please provide dealing type and registration number here
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Will the samples be treated/infected with a hazardous agent?
Note: Includes viral infection of animals and transformation of culture.
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If yes, please provide details here
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Will the samples be fixed/preserved?
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If yes, please provide fixative details here
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Does this research require Institutional Biosafety Committee approval?
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If yes, approval number must be given here
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Please provide a risk assessment for your project samples by establishing one of the following conclusions
Select the most accurate assessment
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Additional sample details (if required)
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Payment details
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Options (select appropriate box)
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Business unit (BU)
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Account (Acc) - Do not change
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Project Grant
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Amount payable
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