IMSERC Account Request

IMSERC Account Request

Please use this form to request first-time, account set-up for IMSERC within NUcore. This form is required of all first-time, IMSERC users, regardless of previous other NU core facility usage or NU internal or external.

Through this process you will gain:

Verification or creation of your NUcore account for IMSERC, giving you the ability to request training and reserve time on facility instruments.
Payment source assignment to your NUcore account, allowing you to bill instrument time in IMSERC. Be aware: your PI/Group leader must approve.
Wildcard access to IMSERC facility and both Technological Institute and SIlverman Hall buildings access for off-hours use of instrumentation.
Integration into IMSERC's remote data storage and backup systems for handling data access remotely.

Reason for Request*

(brief description)

Last Name*

First Name*

Requestor Email*

Please use your official email address: NU email if you're from Northwestern, or your institutional/company email if you're from another organization.

Internal or External to Northwestern*

Are you Northwestern affiliated and/or internal to Northwestern with a NetID and Northwestern-based email? Or are you not affiliated with and/or external to Northwestern?

Select

Northwestern NetID*

NetID is always in the format: abc1234 or abc123

Wild Card ID # (Employee, Student, etc.)*

The ID# is on the front of the wildcard. To learn more about WildCard ID visit this website.

Previous NetID at any point in the past*

Have you ever been issued a NetID at any point in the past due to an affiliation with Northwestern University?

Select

Previous NetID number

If possible,please provide the NetID you were previously issued

IMSERC Access Need*

Select your primary need for IMSERC services

Select

Limited Access Account

Note: Your IMSERC Access will be limited to Supervised use only

In the future if you need to expand your access for research use, return to this form and fill it out with your updated information

Select

Course Number (e.g., CHEM 350)*

Professor Name*

Enter full name of your professor teaching this course

TA Name*

Enter full name of your Teaching Assistant for this course

Research Affiliation: Group, PI, or Organization*

Select your PI from the list. If your PI is not listed, type their name in the field provided. The list is in the format: Last name, First name. (You may enter more than one if applicable).

Select or enter value

Project Chart String*

Make certain you have approval from your PI, research administrator and/or business administrator to utilize this chart string for your research.

Chart String Approver Email*

Please provide the email of the person who approves the chart string (e.g., PI, research administrator, or business administrator).

Department (or Center / Affiliation)*

Select or enter value

Organization Name (include PI, if applicable)*

Enter the name of your organization or company. If you have a designated Principal Investigator (PI), please include their name as well.

Official Billing Address*

Enter your official billing address. This address will be displayed on your invoices.

Billing Contact (or Dept) First Name*

Enter the first name of your organization's primary contact for payment processing and vendor account setup.

This person must be directly reachable for payment inquiries.

(If you pay by credit card and are the designated contact, please use your own name.)

Billing Contact (or Dept) Last Name*

Enter the first name of your organization's primary contact for payment processing and vendor account setup.

This person must be directly reachable for payment inquiries.

(If you pay by credit card and are the designated contact, please use your own name.)

Billing Contact Phone Number*

Enter the billing contact's phone number. We will use this number for any invoice or payment inquiries.

Phone

Billing Contact Email*

Enter the first name of your organization's primary contact for payment processing and vendor account setup.

This person must be directly reachable for payment inquiries.

(If you pay by credit card and are the designated contact, please use your own name.)

Additional Invoice Contacts

Provide ALL additional email addresses to which invoices should be mailed separated with a ;

Payment Method*

Choose the likely desired payment method (regardless of if purchase order is needed).

Select

Will you need any official documentation to begin working with IMSERC?*

Select PO, only if your organization requires a PO# to pay on an invoice. IMSERC does not require a PO.

Select

PO Type*

Select

Scope of Work*

Describe your scope of work, including required instruments, number of samples, timeline, and any relevant details for an accurate quote. If unsure, provide general descriptions and request assistance.

In which technique(s) are you most likely interested?*

Select

Date of Birth*

Enter your Date of Birth in the format: mm/dd/yyyy

Have you communicated with IMSERC staff about your project?*

Select

IMSERC Contact*

Who have you communicated with about your project (select all that apply)

Select or enter value

IMSERC Usage*

If you will be submitting samples to IMSERC staff for them to run/analyze, choose the 1st option. If you will be wanting training to run samples and operate the instruments yourself, choose the 2nd option.

Select

After-hours Access to IMSERC*

Do you require access to IMSERC outside of regular hours or on weekends?

Select

Wildcard Photo

Please upload a photo of yourself at the end of this form or email to IMSERC-ofc@northwestern.edu

Make certain photo adheres to the photo guidelines at: https://www.northwestern.edu/wildcard/get-a-card/photo-submission.html.

Safety Training Acknowledgement*

By checking the below box, I acknowledge and affirm that I have read all IMSERC safety and on-site use policies as detailed on IMSERC website. I have reviewed these policies and procedures, agree to follow all policies detailed and in subsequent trainings, and understand my failure to do so will jeopardize my ability to utilize the facility safely or at all.

I agree to follow all IMSERC policies as detailed in previous and any subsequent trainings.*

Select

You should receive a confirmation email within 3 working days updating you regarding IMSERC set-up.

Please reach out to, IMSERC-OFC@northwestern.edu with any questions.

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