Request for Minors in University Laboratories

Principal Investigator and Department Chair Use Only:

Minor Name *

First

Last

Minor DOB *

Minor Email *

Minor Phone

Department Name *

Department Chair

PI Information

PI Name *

First

Last

PI Email *

PI Phone

Building Name

Lab Room Number(s)

Start Date

End Date

List the personnel who will directly supervise the minor(s) on a daily basis:

Describe research, process, or educational program involving the Minor(s). Please include the list of chemical and biological materials and equipment the minor will be using:

Description of the current research performed in the laboratory on a daily basis. Please include list of current personnel (Post Docs; Graduate and Undergraduate Students; Supervisors, etc.):

Have you reviewed the Minor in Research Laboratories Guideline? *

Is there personal protection equipment available for use? *

Have you and your personnel completed the online laboratory safety training? *

Is the laboratory compliant with all applicable university policies and procedures? *

Principal Investigator Consent Signature (Enter Name) *