Proposal No.
Let the box be empty

Application for UVSOR experiments FY2017 (first or second half)
for foreign researchers[MEXT Nanotechnology Platform Program]
Date:

To IMS Director General:
Representative person:
Name	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  Signature:	  	  	  	  	  	  	  	  	  	  	  	 Affiliation &Position
Street address
CityAddress

State

TEL:
e-mail:Country	  FAX:

Contact person in IMS:Name

We will apply for UVSOR experiments in Institute for Molecular Science through Nanotechnology Platform
Program of Ministry of Education, Culture, Sports, Science and Technology, Japan. We all the members given
below will declare that we will strictly observe the prevention guidelines and rules of research misconducts(malicious fabrications, ill-intentioned data modifications, plagiarizations etc.) in IMS and in our organizations,
if any, and other related rules and Japanese laws. I will also here declare that my organization and I will be
responsible for any unexpected accidents during our experiments. I will promise that the experimental results
should be published.
1. Proposal Title:
2. Beamline and Photon energies you want to use:
□ STXM (BL4U) □XMCD (BL4B) Absorption Edges(e.g. O-K, Fe-L etc.)
3. Representative person and Team Members
No.

Name

Affiliation & Position1234

If the members are more than four, add a member list in a separated sheet.

4. Period:□ First Half FY (April–September)

5. Beamtime Requests

Use a unit of day :multiple bunch operation () days

STXMXMCD□ Second Half FY (October–March): max. 3 days a week (from Wednesday to Friday): max. 4 days a week (from Tuesday to Friday）

single bunch operation (If you select single bunch operation, describe the reason you want it.

) days6. Desired Beamtime Period (Describe when you want to do experiments for 4.□First or □Second Half Year)First priority:
Second priority:
Third priority:
7. Undesired Beamtime Period(Describe if you have for 4.□First or □Second Half Year).)

8. Collaboration with private companies:

□ Yes

□ No

9. List of Samples (Note: You will be requested to submit a detailed sample list after the acceptance of the proposal.)□ Solids□ Liquids□ Gases

10. Research Purposes and Experimental Plans
Attach 1 or 2 pages (A4 or letter) describing all the items shown below.
a) Research significance and originality. In the proposal reviewing committee, the scientific importance, the validity of theUVSOR usage, the previous publications of the applicants will be totally evaluated.
b) Details of the research. If you have previous proposals for the same UVSOR beamlines, describe explicitly the novelty anddifference from the previous ones.
c) Details of experimental plans and conditionsd) Estimation of the beamtime requirede) List of your related publications and previous UVSOR Activity Reports if you haveFor technical issues, contact the person in charge of the beamline & equipment in advance.

11. Usage of liquid He:□ Yes(

12. Facility equipment you want to use:ℓ/day ×□ Yesdays)

□ No

□ No

If you want to use facility equipment that is not always installed at the beamline, choose “yes” and describe the equipment.
Contact the person in charge of the beamline in advance.

13. Equipment you will bringContact the person in charge of the beamline in advance.

14. Usage of equipment in Instrument Center in IMS:
□ Yes
□ No
If yes, name of equipment:□TEM □Microtome □FIB □Others ()I agree with submission of this proposal.
Affiliation & Position:
Name in print:

Date:
Signature:

The person in the box above should not be the proposal representative, but adelegate belonging to the same organization, who can authorize you to doexperiments according to the proposal.
After acceptance of the proposal, you will be requested to submit Radiation
Safety documents for all the members doing experiments at UVSOR. The
document can be valid for FY (April-March) according to the certification.

Director
UVSOR

Beamline
staff

Leave these boxes empty.