Project Application Form Submission Portal Dear colleagues, please complete this form in order to contact the team(s) regarding a new research project involving HNP equipment at Campus Biotech. Please find here the facility guidelines and user fees associated with equipment usage. Project Title* Project Tag* Expected start date* Expected end date* Project Type ApplicationDevelopmentDemo and TrainingPhD projectPostdoc projectTo be defined Applicant's First Name* Applicant's Last Name* Applicant's email address* Applicant's phone number* Principal Investigator's (PI) First Name* PI Last Name* PI email address* PI phone number Institution* Unit/Lab* Funding source* Funding start date* Funding end date* Ethics committee approval (please choose one) ApprovedSubmitted / In progressN/A Name of ethics committee Upload the Ethics decision letter here Type of population PatientsHealthy subjectsPhantomOther Please specify Age range Extra person(s) that need booking access 012345 Extra person 1 Extra person 1's email Extra person 2 Extra person 2's email Extra person 3 Extra person 3's email Extra person 4 Extra person 4's email Extra person 5 Extra person 5's email HNP Facilities involved (required) 7 Tesla MRI - in collaboration with the CIBM Center for Biomedical Imaging3 Tesla MRIMEG - in collaboration with the NCCR Evolving LanguageEEG and psycho-physiologyVirtual Reality and RoboticsNeuromodulationBiomarkersClinical and Sleep Research UnitMethods and Data 7 Tesla MRI - in collaboration with CIBM Number of subjects* Hours per subject* Total number of hours* Other special MRI requirements and services Operator trainingAssistance with data acquisitionAssistance with data analysisAssistance from MR expertVisual stimulationAuditory stimulationEye-trackerPhysiological measurements using Biopac Other specific requests 3 Tesla MRI Number of subjects* Hours per subject* Mock ScannerEye TrackerBiopac MP160Research assistant Other specific requests MEG - in collaboration with NCCR Evolving Language Number of subjects* Hours per subject* Eye Tracker Other specific requests EEG and Psycho-physiology Number of subjects* Hours per subject* Eye TrackerShielded experimental booth for EEGNon-shielded experimental boothWearable sensing DSI2464-channel BranAmp MR+64-channel ANT Neuro128-channel ActiCHamp256-channel EGI GES400Biopac MP36RBiopac MP160 – BionomadixEye-trackerExpert / engineer time (development) Other specific requests Virtual Reality and Robotics Number of subjects* Hours per subject* VR motion capture room (H4.02)MRI-compatible motion capture systemBooth with VR setupHoloLens 2HTC Vive Pro EyeOculus Quest 2TabletsXsense motion captureQuattrocento HD-EMGExpert / engineer time (development) Other specific requests Neuromodulation Number of subjects* Hours per subject* MagStim BiStimMagStim Super Rapid PlusMagventure MagPro XP - compatible with 3T MRIBrainSight neuronavigationNoraxon Wireless EMG + desktop receiverNeuroconn DC stimulator +Digitimer DS7ANeuroelectrics StarStim8Neuroelectrics StarStim tCS HomeHasomed Rehamove3Neuromodulation roomExpert / engineer time (development) Other specific requests Biomarkers Number of subjects* Samples per subject* Blood samplingSalivary biomarker analysisBlood biomarker analysisGenetic AnalysisBlood sample treatment and storage Type of biomarkers needed Other specific requests Clinical and Sleep Research Unit Number of subjects* Hours per subject* Medical assistantBedroom overnight with EEGV-amp EEG system in roomAvatar system in roomAvatar system outside Campus BiotechNeuropsychological testsInterview room - behavioral testingInterview room - long setupKitchen areaExpert / engineer time (development) Other specific requests Methods and Data Expert / engineer time (development) Other specific requests Project information Keywords that describe your project (separated by ",")* Background and significance* Research plan* Imaging protocol* Approach to image data analysis Additional hardware or software requirements Equipment use in other locations Billing Address* City* State/Province Zip/postal Country* Comments (optional) Link to facility guidelines and user fees I have read the facility guidelines and user fees, and understand the rates associated with my project.
