CENTRE OF EXCELLENCE IN NANOELECTRONICS (CEN) Indian Institute of Science, Bangalore 560 012 Equipment Usage Authorization Form

1) Name 2) Department or Organization : :

3) Degree registered (If applicable) : 4) Advisor (Or Supervisor) : :

5) Equipment to be used (one form for each equipment)

6) How often do you plan to use the equipment? (Please tick the right option)

Once a week Once a month

Once in two weeks Once in 6 months

7) Your contact phone number (preferably mobile) : 8) Your contact email address :

Signature of the student/user

Signature of the advisor/supervisor

Signature of approving faculty at CEN For Office Use Date of form submission: Starting date of usage of equipment: