Research at Ameri Supervisor Name * Supervisor Email * Project Description & Equipment Needed* Safety Certificates * Completion Date - HazCom: In Sync with GHS * Completion Date - Laboratory Hazard Awareness* Completion Date - Fire Safety * Combine a copy of your University Panther ID (or a government issued picture ID) with all safety certificates into a single .pdf file and submit * Application will not be processed without safety certifications Ameri Orientation Meeting * Date and Time Tool and Door Access Facility online manager (FOM) account username * A facility online manager (FOM) account is required to access the facility and to login and access research tools. Please go to fom.fiu.edu to create an account and input your username here. If you do not have an active account, your form will not be processed. Room Access, Please select the rooms that you need access to based on your research and training profile. * External Doors, 1650WN/WSSamples Prep, 1650Microscopy Suite, 1656Clean Room, 1655XRD, 1662 (Req. Cert.)Thermal Processing/3DPrinting, 1661Packaging Lab, 1660 User/AMERI Agreement (Read below and type your name in the box to acknowledge)* By signing above, the User warrants that (s)he has been provided with the AMERI USER GUIDE and understands and agrees to abide by the usage rules and safety provisions discussed in the manual. While the User will be trained in general chemical safety and tool operation before being allowed to use an equipment required by his/her work, the User assumes primary responsibility for his/her personal safety. It is expected that the User will operate all instruments and equipment in a safe and professional manner, consistent with the operating instructions and the Laboratory rules. The User represents that her/his knowledge of chemistry and general laboratory practice is advanced enough to permit the safe pursuit of project goals. The User acknowledges that the AMERI Facility is a research enabling center and that the User retains ultimate responsibility for project progress and development. FIU does not in any way warrant or assure a particular project result. Additionally, by signing above, the User agrees to abide by the FIU Code of Conduct (compliance.fiu.edu) and the FIU Policy regarding abuse of computers and network systems (it.fiu.edu/about/fiu-code-computing-practice) Finally, the User acknowledges that access to the AMERI facility and the use of lab resources is a revocable privilege and not a right. Rogue behavior and non-compliance with lab practices and rules established by AMERI staff will not be permitted and will result in a loss of access privileges. Safety violations, regardless of intent, may result in instant revocation of access depending on the severity.