Analysis Request Form

Use this form to request an analysis from IIRMES. After submitting this form, an IIRMES representative will contact you to collect additional information about your request.

* marks a required field.

Please identify yourself (required) Student PI IIRMES staff

PI Contact Information

Please enter the contact information for your PI.

PI First Name*

PI Last Name*

PI Email*

Your Contact Information

First Name*

Last Name*

Email*

Are you from CSULB?*

Yes No

College*

Department*

Institution/Organization*

Staff ID*

Research Project Title*
Please enter the working title of your research project. Description*
Briefly describe the overall research project that this analysis will serve.

Analysis Request Analysis Type*
Please note that a different request will be needed for each type of analyses. Analysis Target*
Please provide a brief description of the target chemical(s) or molecule(s) to be analyzed. Level of Service* Number of Samples*
How many samples will undergo this analysis? (integer only) Description of Samples*
Please describe the type of sample to be analyzed (e.g. water, tissue, sediment) and how the sample will be prepared before arrival at IIRMES. Additional Comments / Special Requests Desired Completion Date
Requried for student and PI: please pick the date you would like the analysis to be complete.