APS User Agreement Questionnaire

Individuals who are not Argonne employees are not permitted to do hands-on work at the Advanced Photon Source until we have executed a User Agreement (UA) with that individuals home institution. Please fill in the requested information so that the Advanced Photon Source UA Specialist can furnish the appropriate User Agreement(s) to your institution for signature.

Press the "Submit" button at the bottom of the page when you have completed the questionnaire. Thank you!
(Note: this form may be printed and returned by fax or mail. To print a copy of the form, click here.)

Address any questions to:

Anne Owens
User Agreement Specialist
X-Ray Science Division, Advanced Photon Source
Argonne National Laboratory Bldg 401
9700 South Cass Ave.
Argonne, IL 60439
Phone: (630) 252-7833
Fax: (630) 252-3222
E-mail: aowens@aps.anl.gov

Question 1)
Name of the institution, as you wish it to appear in the Agreement(s):
Question 2)
Select which category best describes your institution:
Question 3)
If the institution is a DOE lab, what is the DOE Contract Number?
Question 4)
If the institution is a financially contributing member of a CAT, which CAT?
Question 5)
If coming under GUP (General User Program), which CAT will be the initial host for personnel from the above-named institution?
Question 6)
When will personnel from the above-named institution begin working at the APS?
Question 7)
Will anyone from a Howard Hughes Medical Institute laboratory work at the APS under this Agreement?		 Yes
No
Question 8)
To whom should the User Agreement(s) be sent?

Name: 

Address: 

Phone: 

Fax: 

E-mail: 

Question 9)
Contact information for the person completing this questionnaire (if different from above):

Name: 

Phone: 

Email: 

Question 10)
Will employees/students of the above-named institution participate in beamline design, installation, and/or commissioning activities at the APS?		 Yes
No (if "No," skip to question #12.)
Question 11)
Will the above-named institution spend U.S. Government funds, provided through a contract, grant, or other agreement that includes patent/data terms and conditions, to support the activities listed in question #10?		 Yes, this will be true for all such activities and all participants
Yes, this will be true for some but not all activities/participants
No
Question 12)
What type(s) of experiments will be done at the APS by employees/students of the above-named institution?		 Prior to answering, please visit this link Opens in a new window to review the explanations of nonproprietary vs. proprietary hands-on-work at DOE user facilities.
Nonproprietary (also answer question #13.)
Proprietary (also answer questions #14 and 15.)
Both Nonproprietary and Proprietary (also answer questions #13, 14, and 15.)
Question 13)
Will the above-named institution spend U.S. Government funds, provided through a contract, grant, or other agreement that includes patent/data terms and conditions, to support the performance of nonproprietary experiments at the APS?		 Yes, this will be true for all nonproprietary experiments and all participants
Yes, this will be true for some but not all experiments/participants
No 
Question 14)
Will Argonne personnel be used in the design or operation of proprietary experiments at the APS?		 Yes 
No 
Question 15)
Does the institution have a corporate presence with manufacturing capability in the U.S.?		 Yes 
No 

Form revised 2/5/2007