Catalyst Application Form

Catalyst Application

Your Name (required) *

Affiliation/Institution (required) *

Phone Number (required) *

Address (required) *

E-mail Address (required) *

Research Discipline (required) *

Please choose one of the following: (required) *

Educator (Teacher/Faculty Member)

Student (Complete the Students Only section below.)

Researcher

OtherOther

Students Only: If you are a student, you must provide your Research Adviser's name and email address.

Project Title

Project Description: Describe project rationale, proposed work plan, necessary equipment, materials and supplies. Limit to 300 words. (required) *

Which SENIC facility do you intend to use?

Georgia Tech

Joint School of Nanoscience and Nanoengineering

Not Sure

Justification: Provide a justificiation for free use of SENIC facilities. Limit to 200 words. (required) *

Impact Statement: Describe anticipated impact on research, education, training of under-represented users or users from non-traditional disciplines. Limit to 200 words. (required) *

If you are human, leave this field blank.

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