Lucas Center: Safety & Policy Review and User ID

Lucas Center: Safety & Policy Review and User ID

Please read all of the following information carefully before completing the form below.

This form is required for all researchers, faculty, students, and staff planning to conduct MR scans at the Lucas Center.

After you submit this form, it will be reviewed by Lucas Magnet Manager Anne Marie Sawyer and you will be given a date to attend a Lucas MR Safety and Policy Review session (typically 1 to 3 weeks from the date that you submit this form).

After completion of your Lucas MR Safety and Policy Review session, you will receive a User ID for accessing the scanner scheduling web site where you can sign up for scan time.

You can not begin scanning nor enter any of the magnet rooms at the Lucas Center until you have attended a Lucas MR Safety and Policy Review session and obtained a User ID.

By filling out the form below...
- you agree to be actively involved in MR studies at the Lucas Center for a minimum of 6 months, and
- you are using an email account that you check regularly.

If you do not scan or assist with a scan within 3 months of your Safety and Policy Review session, you will be required to attend a session again.

Each year, you will be required to attend an Annual Lucas MR Safety and Policy Review session to continue scanning.

Items in red are required.

Name:			PhD MD MS MA BS BA Other:
	first name	last name

Email:

Date Of Birth:		Gender:	Female Male
	mm/dd/yyyy

Office Address:
	street address	building name	room


	city	state	zip	mail code

Office Phone:		Pager:		Fax:
	xxx-xxx-xxxx (ext)		xxx-xxx-xxxx (id)		xxx-xxx-xxxx

Home Phone:		Cell Phone:
	xxx-xxx-xxxx		xxx-xxx-xxxx

Position:		Other:

Affiliation:		Other:

Supervisor:		Other:			PhD MD Other:
			first name	last name

Principle investigator for your studies:			PhD MD Other:
	first name	last name

Second Principle investigator for your studies:			PhD MD Other:
	first name	last name

Your function will be:	Operating the scanner Assisting other researchers Scheduling scan time Principal Investigator

Previous experience using MR scanners:	Yes No

How long do you plan to be scanning at the Lucas Center:
	years	months

Date you would like to start scanning at the Lucas Center:
	mm/dd/yyyy

Person(s) who will teach you how to operate the scanner and equipment:

		PhD MD Other:
first name	last name

		PhD MD Other:
first name	last name

		PhD MD Other:
first name	last name

Researcher(s) who you will be assisting at the Lucas Center:

		PhD MD Other:
first name	last name

		PhD MD Other:
first name	last name

		PhD MD Other:
first name	last name

User ID & Password

For your User ID below, enter your last name (lower-case letters only, omit hyphens).

If your last name has more than 10 characters, enter only the first 10 characters.

If your last name has less than 3 characters, add the initial of your first name at the end (e.g., Ping Li would enter "lip").

Your password must contain 6 to 20 characters (case-sensitive).

Please use your first name as your password.

Your lab may have a shared password or a password policy to allow lab members access to each other's accounts. Please check with your lab supervisor.

Please record your User ID and Password because you will be asked to enter both each time that you sign-up for scanner time.

User ID:		Password:
				enter again

Group IDs

If known, enter a list of the 6-character Group IDs that identify your projects (e.g., glov1u, sawy3f).

If you have not yet been given a Group ID, please contact your supervisor or Anne Marie Sawyer.

You can leave this blank now, but you will not be able to sign up for scan time until you are a member of at least one group.

Group IDs:
	comma-separated list

Notifications

When other users cancel scan time, you can receive automatic emails notifying you that time has become available.

Select the scanners for which you want to receive these notifications.

Select how far in advance of the scan date the cancelations should be (i.e., days between the cancelation and the scan time).

Scanners:	1.5T (Lucas P163) 3.0T #1 (Lucas P021) 3.0T #2 (Lucas P173) 7.0T (Lucas PS014) MRT (Hospital)	Advance notice:	less than 3 days 3 days or more