International job shadowing program Application form Survey

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* 1. Contact information

Full Name

Host organization

City/Town

Country

Email Address

Phone Number

Please double check your email.

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* 2. Name of the imaging facility

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* 3. Is your facility affiliated with any of the imaging infrastructures or networks below?

Advanced BioImaging Support (Japan)

BioImaging North America (BINA)

Canada BioImaging

Euro-BioImaging ERIC

India-BioImaging Consortium

Latin America BioImaging

Microscopy Australia

National Imaging Facility (Australia)

National Laboratory for Advanced Microscopy (Mexico)

SingaScope (Singapore-Wide Microscopy Infrastructure Network)

South Africa BioImaging

Other imaging infrastructure/network (please specify)

My facility is not affiliated with any imaging infrastructure/network

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* 4. Address of the facility sending a staff member

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

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* 5. Your position

Core facility director

Technical staff

Managerial staff

Trainer or Teacher

Other (please specify)

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* 6. Your field(s) of expertise

Light microscopy

Electron microscopy

Preclinical imaging

Medical imaging

Image analysis

Software development

Other (please specify)

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* 7. Imaging technologies and related services you are expert in

Multi-modal advanced light microscopy

Super resolution microscopy

In vitro functional Imaging (Fluorescence and Raman spectroscopy)

High-throughput microscopy

Electron microscopy

Correlative light-electron microscopy (CLEM)

Mesoscopic imaging

PET, SPECT

MRI/MRS

Ultrasound

Optical imaging

Photoacoustic imaging

Dual PET (or SPECT)/CT

Dual PET (or SPECT)/MRI

Phase contrast imaging

Population imaging

Image and data analysis

Animal models

Imaging probes

Cell culture

Other (please specify)

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* 8. For how long have you been working at an imaging facility or a service provider?

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* 9. Please describe in a few words (max. 200) your current tasks at your imaging facility or as a service provider.

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* 10. Name of the imaging facility you are applying to (if there are several, please list from the most preferred to the least preferred option)

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* 11. What kind of job shadowing are you most interested in?

Aspects related to user access

Quality management

Software tools

Image data analysis

Image data storage and management

Facility organization and management

Latest imaging technologies

Instrument operation

Other (please specify)

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* 12. Please upload your CV

Upload your CV here.

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.

Choose File

If you had problems uploading the CV, you can also send it directly to gleb.grebnev@embl.de

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* 13. Please describe in a few words (max. 200) your expectations about this shadowing program:

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* 14. If you are NOT a core facility manager, please upload a letter of approval of the application signed by your supervisor/facility manager

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.

Choose File

If you had problems uploading the letter of approval, you can also send it directly to gleb.grebnev@embl.de

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* 15. Please indicate if you need support for your travel:

No, I do not need support for my travel

Yes, I need support to cover only my travel costs (costs of flights, trains, buses, etc.)

Yes, I need support to cover only my accommodation costs

Yes, I need support to cover both my travel (costs of flights, trains, buses, etc.) and accommodation costs

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