subject_line
Perkins North (QEII) - CMCA/Human NIF Facility - Request for Access Card/Change Form
Applicants details
First Name
*
Last Name
*
Email Address
*
Do you have a UWA Pheme number
*
Yes
N/A
UWA Pheme Number
*
Contact Number
*
Residential Suburb
*
Position Title
*
Department
*
Research Group/ Supervisor
*
Existing Card Number (if applicable)
*
Office/desk number (located on the bottom shelf above the computers e.g.- 224-A5) if applicable
*
Application for:
*
New Card
Lost Card
Change of Access
Type of Access:
*
No change
Student - Honours (Restricted Access 6am-6pm)
Student - Masters (Restricted Access 6am-6pm)
Student - 1st year PhD (Restricted Access 6am-6pm)
Student - 2+ year PhD
Short Term Visitor - (No Restrictions)
Short Term Visitor - (Restricted Access - Monday to Friday 6am-6pm)
Long Term Visitor - (No Restrictions)
Long Term Visitor ( Restricted Access - Monday to Friday 6am to 6pm)
Fixed Term Contract - (No Restrictions)
Fixed Term Contract - (Restricted Access - Monday to Friday 6am -6pm)
Permanent Staff
Ongoing - (No Restrictions)
Start Date
*
+
End Date
*
+
Inductions:
*
Completed the CMCA Induction
Completed the NIF Induction
Completed the Building Induction
Access to:
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CMCA Facility
Human NIF Facility
Requested Access
*
CMCA Office only - 24/7
CMCA PC1 - 24/7
CMCA Access - Monday to Friday 8am - 5.30pm
CMCA Access - 24/7
CMCA Access and MRI - Monday to Friday 8am-5.30pm
CMCA Access and MRI - 24/7
CMCA Access and Super-res Lab - Monday to Friday 8.00am -5.30pm
CMCA Access and Super-res Lab - 24/7
CMCA Access + MRI + Super-res - M-F 8.00am-5.30pm
CMCA Access + MRI + Super-res 24/7
Requested Access
*
Waiting area
NIF offices
NIF Store
PET area
MRI Zone 2
Hotlab
MRI Zone 3
NIF back of house
End of Trip Facility Access;
No change
Bike Storage
Bathrooms/Lockers
Applicants Signature
*
clear
Name of Supervisor to Approve Request:
*
Alysia Hubbard
Catherine Rinaldi
Diana Patalwala
Fiona Moggach
Heidi Espedal
Jahmila Parthenay
Joseph Ioppolo
Liisa Hirvonen
Michael Clarke
Minakshi Das
Peter King
Sjoerd Vos
Tim Rosenow
Other