ACERT: Service Request Form

Cornell University Chemistry and Chemical Biology

National Institute of General Medical Sciences
	National Biomedical Resource for Advanced ESR Spectroscopy

ACERT Service Request Form

Some planned features of this page are still in development. Additional options will become visible as they are implemented.

last update: October 28, 2022

Contact Information.

All fields in this section are required except Middle Name and Title.

First name: *

Middle name or initial(s):

Last name: *

Title:

Phone #: *

Email: *

PI/Lab Group: *

PI Phone #: *

PI Email: *

Department: *

We need the following information to summarize user demographics for reporting purposes:

Demographics Information

Sex: *
Female
Male
Prefer not to specify

Ethnicity: *
Hispanic/Latino
Non-Hispanic
Prefer not to specify

Race: *
American Indian or Alaska Native
Asian
Black or African American
White
Native Hawaiian or Other Pacific Islander
Other
Prefer not to specify

Are you disabled: *
No
Yes (check all that apply):
     Mobility/Orthopedic Impairment
     Hearing
     Visual
     Other
Prefer not to specify

Institutional Affiliation

Affilation Type: *
Educational
Commercial
Other

If "Other," please provide a very brief description (e.g., "Medical Center," "Independent Investigator," etc."):

If you have no institutional affilitation, just write "None" in the name field

Name of Affiliated Institution:

City:

State or Region:

Postal Code:

Country:

The following section is optional:

Request Details

Request Type:

ESR Measurement
Spectral Analysis
Training
Other
Uncertain

If you select "Other" or "Uncertain," an ACERT staff member will contact you for consultation.
If "Other," please provide a very brief description:

Project info (for "ESR Measurement" or "Spectral Analysis")

Please describe your planned research to the best of your ability. If you are new to ESR, please include the phrase "I'm new to this" at the start of your description. One of our team will contact you for further details and planning.

Title:

Brief Description (3-4 sentences):

Click to submit your request:

Site Map

Home

About ACERT
ACERT News
Personnel

Research
   Available Resources
   Technologies
   Research Highlights
   Collaborations

Outreach
   Dissemination
   Training/Workshops
   Publications
   Useful Links

ACERT is supported by grant 1R24GM146107 from the National Institute of General Medical Sciences (NIGMS), part of the National Institutes of Health.

National Biomedical Resource for Advanced ESR Spectroscopy

Baker Laboratory of Chemistry
259 East Ave.
Ithaca, NY 14853

National Institute of
General Medical Sciences