UNIVERSITY OF WARSAW		
HEAVY ION LABORATORY		
	Beam request form

Title of the experiment (full length description should be attached):
..........................................................................................................................................................................................................................................................................................................................................................
Spokesperson
Name: ...............................................................................................................................….
Affiliation: ...........................................................................................................................…
Mailing address: ................................................................................................................…
.........................................................................................................................................…..
Tel.: ................................................................ Fax: ......................…….............................…
E-mail ...............................................................................................................................….
Contact person at HIL: ...................……………………………………….................................
Name(s) and affiliation(s) of collaborator(s): 
Participants	Institution	Names	

Ion species
	Energy/nucleon (MeV/A)	Minimum beam current before the experimental stand (pnA)	Number of
8-hour shifts	
	Min	Max			

Total requested beam time: ...............................................................…………..............
	
Preferred time period for the experiment: .......................................................................…..
Earliest starting date: …...........………………………....………..............................................
Periods absolutely excluded: ……………………..........………………………………………... 
Experimental set-up:   Internal beam,     Radiobiology,        Separator,       Eagle,       Icare,      Other 

Additional comments (special requirements for the beam or experimental equipment, own equipment that will be installed, equipment and assistance expected from HIL, etc …)	

ENSAR Transnational Access Funding is requested for the following persons: 
Participants	Institution	Names	

Before submission of the proposal, please consult the following persons  (your contact person at HIL can support you in this procedure):
-	beams: 	P. Gmaj tel. +48 225546326, e-mail  p.gmaj@slcj.uw.edu.pl
-	data acquisition: 	M. Kowalczyk, tel. +48 22 5546115, e-mail: mkk@fuw.edu.pl 
-	electronics: 	M. Kisieliński, tel. +48 22 5546329, e-mail: kisiel@slcj.uw.edu.pl 
-	radioprotection:  	R. Tańczyk,  tel. +48 22 5546115, e-mail: tanczyk@slcj.uw.edu.pl 
-	experimental area: 	A. Jakubowski, tel. +48 22 5546249, e-mail: ajak@slcj.uw.edu.pl 

Final approval (to be filled by HIL):

Required attachments:

1.	Full description of the experiment including rate estimate – please provide details which make possible verification of the calculation. The proposal should define subjects which can be finalised or at least well advanced during the considered beam-time allocation period.

2.	Information on PhD theses to be based on this experiment (Name, date of beginning, expected date of completion).

3.	List of grants related to this experiment (e.g. Polish Ministry of Science and Higher Education, FP7 funding, other - grant title, date of beginning, date of completion).

4.	List of all papers of your team, which resulted from measurements at HIL.