Research Centre forToxicCompounds in theEnvironment, Kamenice 753/5, Pavilion A29, 625 00 Brno

/ APPLICATION FORM
Traceanalyticallaboratories
for internal users
  1. Applicant:

Name:
E-mail:
Affiliation:
Group:
  1. Project:

Name:
Expected start date:
Expected end date:

Your assistance in laboratory procedures: YESNO

General information:

Type of services:

Sampling

Samples clean-up

Analysis

Data interpretation

Data analysis

Which compounds do you want to analyze in witch matrices?

How many samples?

CLEAN-UP (write your needs or comments to Trace laboratory staffs):

ANALYSIS:

Have you added any standards (incl. PRC)? If yes, specify:

Brief introduction of analytical procedure (samples volumes, fractionations, final volume etc…)?

Do you need the samples back after measurements? YES NO

Could be the samples discarded after measurements? YES NO

DATA INTERPRETATION AND VIZUALIATION:

Do you need the final results? YES NO

Do you want just raw data to be calculated yourself? YES NO

Could data be import data to GENASIS database? YES NO

data public available YES NO

If yes, please note,data sets to be imported into the GENASIS database have to contain specific mandatory information listed below (cross marked items in the list). The items below are required for correct import and integration of your data into the GENASIS database):

Site description:

☒Name of the site

☒Geographic coordinates of the site

Sample description:

☒Matrix (including specification)

☒Sampling method

☒Sampling date (e.g. from/to)

EXPECTED OUTCOME

Thesis (Bachelor, Master, Ph.D)
Progress/Final report
Poster
Conference presentation
Peer reviewed article
Other (please specify)

When do you need the results?

Is the excel file with sample description attached? YESNO

Date:Signature:

Evaluation of received application

(to be completed by the institution)
  1. Technical feasibility of the proposed research project at facility YES NO
Date: Signature of core facility head:
  1. Scientific excellence of the proposed research project YES NO
Quarterly decision made by Extended Executive Board
We hereby confirmed that the application is
accepted from (month) (year) till (month) (year)
not accepted
...... ......
Date Signatureof Centre director/infrastructurecoordinator Stamp of institution