Shadowing program application form Survey

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* 1. Personal information

Name *

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address *

Phone number *

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* 2. Name of the imaging facility

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* 3. Country

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* 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 (Canada, Mexico, USA)

Canada BioImaging

None of the above

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* 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 *

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* 6. Position:

Core facility manager

Technical staff

Other (please specify)

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* 7. Field of expertize:

Biological imaging

Biomedical imaging

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* 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

CLEM

Mesoscopic imaging

PET, SPECT

MRI/MRS

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)

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* 9. For how long have you been working at your imaging facility?

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* 10. Please describe in few words (max. 200) your current tasks at your imaging facility:

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* 11. Name of the imaging facility you are applying to:
(if several possibilities, please list from the most preferred to the least preferred option)

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* 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)

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* 13. Please upload your CV

PDF, DOCX, DOC file types only.

Choose File

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* 14. If you had problems uploading the CV, you can also send it directly to federica.paina@embl.de

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* 15. Please describe in few words (max. 200) your expectations about this shadowing program:

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* 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

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* 17. If you had problems uploading the letter of approval, you can also send it directly to federica.paina@embl.de

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* 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.

Question Title

* 1. Personal information

Question Title

* 2. Name of the imaging facility

Question Title

* 3. Country

Question Title

* 4. Research Infrastructure/Network

Question Title

* 5. Address of the facility sending a staff member

Question Title

* 6. Position:

Question Title

* 7. Field of expertize:

Question Title

* 8. Imaging technologies and related services you are expert in:

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?

Question Title

* 13. 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

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

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.

* 11. Name of the imaging facility you are applying to:
(if several possibilities, please list from the most preferred to the least preferred option)

* 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.