Booking form for students Apply for space at Kristineberg Marine Research Station – applied project and degree project Please fill in your aplication for access and resources at Kristineberg. The more accurate information you give, the better we can provide the resources you need. Boxes with an asterisk (*) are mandatory to fill in. Personal information Given name and family name * Postal address Phone E-mail address * University information University/company etc. * Department * Studies information Day of arrival * Day of departure * Course level Basic level Advanced level Not applicable Number of higher education credits (hec) on course 7.5 (applied project) 15 (degree project) 30 (degree project) 45 (degree project) 60 (degree project) No course, instead internship Course or internship as student registered on course at University of Gothenburg, enter course code exchange student financed through ERASMUS other Supervisor * Research contact at Kristineberg, (if any) Brief description of the project * Brief description of the project Species included in the project * Species included in the project Species included in the project * Species included in the project * Are experiments on vertebrates or cephalopods included? Yes (include authorization from the ethical committee on animal experiments) No Do not know, supplemented later Include authorization from the ethical committee on animal experiments * Include authorization from the ethical committee on animal experiments Are work with alien species and/or alien populations included? Yes No Do not know, supplemented later Specify species and/or population * Are work with radioactive substances included? Yes, special permit is required (specify isotope and activity in MBq) No Do not know, supplemented later Specify isotope and activity in MBq * Are work with other hazardous substances requiring labelling included? Yes No Do not know, supplemented later Specify substance * Are microbial work and/or work with GMO (genetic modified organisms) included? Yes No Do not know, supplemented later Please specify * Need for resources Desk space (offered only for longer stays) Yes No Do not know, supplemented later Laboratory space Yes No Do not know, supplemented later Specify type and space in m2 * Space in thermoregulated rooms Yes No Do not know, supplemented later Specify temperatures, if you want to regulate water, air temperature, or both. Specify if you want to use deep, surface water, or both. And how much space you need (m2). * Other space for aquarium tanks Yes No Do not know, supplemented later Specify m2 * Need of special instruments Yes No Do not know, supplemented later Please specify2 * Other need for laboratory resources Yes No Do not know, supplemented later Please specify3 * Does the task require diving? Yes No Do not know, supplemented later Specify diving competence qualification * Need of research vessel Alice Yes No Do not know, supplemented later Specify number of hours * Meals Yes No Do not know, supplemented later Specify any requests for special diets * Accommodation Yes No Do not know, supplemented later Other special requirements I accept that my name will be visable in the list of visitors in the stations lobby during my visit. Consent for storing submitted data * Yes, I give permission to store and process my data Submit Contact Booking, KristinebergPhone: +46 31 786 95 00booking.kmf@polar.se
