MRI Research Protocol Submission (Facility Utilization Form)
PI First Name
PI Last Name
Anesthesiology and Perioperative Medicine
Biochemistry and Molecular Biology
Cellular and Molecular Physiology
Family and Community Medicine
Microbiology and Immunology
Neural and Behavioral Sciences
Obstetrics and Gynecology
Pathology and Laboratory Medicine
Physical Medicine and Rehabilitation
Public Health Sciences
Research Coordinator First Name
Research Coordinator Last Name
Research Coordinator Phone
Research Coordinator Email
Financial Contact First Name
Financial Contact Last Name
Financial Contact Phone
Financial Contact Email
Full Billing Address (include mailcode if applicable)
Study Type (check all that apply)
Specify Study Type
Will Center for NMR Research researchers be involved?
List Center for NMR Researchers Involved
Upload IRB Approval Letter
Upload Consent Form
Upload IACUC Approval Letter
Will services of the Center for NMR Research Anatomical Image Analysis be used?
Upload Data Acquisition Priority Form Signed by Director of Lab
Will other Center for NMR Research equipment be required?
Describe Required Center for NMR Research Equipment
Will other non-Center equipment be required?
Describe Required non-Center Equipment (must seek approval from the Center to use)
Is the study funded?
Budget Routing Number
Limited support may be granted by the Center to unfunded junior researchers. If interested, upload a letter requestig such support.
Animal 7 Tesla
Human 3 Tesla Siemens
Start Date Requested
Number of Sessions Requested
Duration of Each Session (hours)
Abstract of Proposed Research
Summarize aims/hypothesis and background/significance. Provide enough information on scientific rationale to allow for evaluation of scientific merit. Also provide details of sequences and parameters used for the imaging studies.
Summarize research plan. Provide enough information on scientific rationale to allow for evaluation of scientific merit. Also provide details of sequences and parameters used for the imaging studies.
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