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Remote Access Request Form
- This request form is no longer in use, please use updated form at:
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First Name
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Last Name
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E-mail
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Institution
Phone Number
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Skype Name
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City
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State
Country
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Approximately how many students will participate?
5 or less
5 to 10
10 to 20
20 to 25
More than 25
Instrument(s) of interest (check all that apply)
AFM
FESEM
Profilometer
UV-Vis
TEM Institution/Organization Name
Institution Type
-- Select --
Middle school
High school
Tecnical high school
2 year college
4 year college
Other
If you selected "other", please take a moment to describe your organization:
What level of mathematics background do your students currently have?
-- Select --
Below high school proficiency
High school level proficiency (algebra, trig, geometry)
100/200 colleve level courses
300/400 college level courses
Do you currenty offer a nanotechnology course at your institution/organization?
-- Select --
Yes
No
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Check all in-house samples that you would be interested in viewing/characterizing
Gold nanoparticles
Nickel nanowires
Silicon nanowires
Block copolymers
Starch granules
Butterfly wing
Compact disk
I have my own sample(s) that I will ship to you
Select a date and time (ET zone) for your remote
test session
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Select a date and time (ET zone) for your remote
lab session
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Month
Day
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Rank the following in order of importance, with 1 being the most important.
The focus or goal of participating in this remote access session is to ...
Help students learn how characterization equipment fundamentally works
-- Select --
1
2
3
4
5
6
Help students learn how to interpret data from the equipment
-- Select --
1
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5
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Help students learn how to operate the equipment
-- Select --
1
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Help students understand fundamental science concepts
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1
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Help students learn about nanotechnology
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1
2
3
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5
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Teach myself about characterization techniques
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1
2
3
4
5
6
Would you be interested in having a Powerpoint presentation/discussion on any of the following topics? Please check all that apply.
Introduction to Nanotechnology
Introduction to Characterization
Atomic Force Microscopy
Field Emission Scanning Electron Microscopy
Profilometry
UV-Vis Spectroscopy
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