Shadowing program application form Question Title * 1. Personal information Name * Address City/Town State/Province ZIP/Postal Code Country Email Address * Phone number * Question Title * 2. Name of the imaging facility Question Title * 3. Country Question Title * 4. Research Infrastructure/Network Euro-BioImaging Advanced BioImaging Support (Japan) Microscopy Australia National Imaging Facility (Australia) National Laboratory for Advanced Microscopy (Mexico) South Africa BioImaging India-BioImaging Consortium Singapore Microscopy Infrastructure Network BioImaging North America (BINA; Canada, Mexico, USA) Canada BioImaging None of the above Other (please specify) Question Title * 5. Address of the facility sending a staff member Contact person * Title Address City/Town State/Province ZIP/Postal Code Country Email Address * Phone Number * Question Title * 6. Position: Core facility director/manager Technical staff Managerial staff Other (please specify) Question Title * 7. Field of expertize: Biological imaging Biomedical imaging Question Title * 8. Imaging technologies and related services you are expert in: Multi-modal advanced light microscopy Super resolution microscopy In vitro functional Imaging (Fluorescence and Raman spectroscopy) High-throughput microscopy EM CLEM Mesoscopic imaging PET, SPECT MRI/MRS CT Ultrasound Optical imaging Photoacoustic imaging Dual PET (or SPECT)/CT Dual PET (or SPECT)/MRI Phase contrast imaging Population imaging Image and data analysis Animal models Imaging probes Cell culture Other (please specify) Question Title * 9. For how long have you been working at your imaging facility? Question Title * 10. Please describe in few words (max. 200) your current tasks at your imaging facility: Question Title * 11. Name of the imaging facility you are applying to:(if several possibilities, please list from the most preferred to the least preferred option) Question Title * 12. What kind of job shadowing are you most interested in? Aspects related to user access Quality management Software tools Image data analysis Image data storage and management Facility organization and management Latest imaging technologies Other (please specify) Question Title * 13. Please upload your CV PDF, DOCX, DOC file types only. Choose File Choose File No file chosen Remove File Please upload your CV Question Title * 14. If you had problems uploading the CV, you can also send it directly to federica.paina@embl.de Question Title * 15. Please describe in few words (max. 200) your expectations about this shadowing program: Question Title * 16. If you are NOT a core facility manager, please upload a letter of approval of the application signed by your supervisor/facility manager PDF, DOCX, DOC file types only. Choose File Choose File No file chosen Remove File If you are NOT a core facility manager, please upload a letter of approval of the application signed by your supervisor/facility manager Question Title * 17. If you had problems uploading the letter of approval, you can also send it directly to federica.paina@embl.de Question Title * 18. Please indicate if you need support for your travel No, I do not need support for my travel Yes, I need support to cover my travel costs Yes, I need support to cover my accomodation costs Yes, I need support to cover my travel and accomodation costs Question Title * 19. We will process your personal data with the utmost confidentiality.For more information please read our Information for Data Subjects here.If you want to leave a comment please use the text box below. Done