Complete this form if you are a group leader wishing to host an event at the Station, or a research program leader (e.g. PI, postdoc, grad student) wishing to conduct work here. Only one form per project/activity is needed. This form also lets you request research support. Housing reservations are done separately: Visiting groups (e.g. events, conferences, meetings) will be contacted by someone from MLBS following completion of this form. Individual Station users must complete a housing request to secure a reservation following approval of this application. Fields with red asterisks are required. Personal Information First Name * Middle Name Last Name * Your Home Institution Contact Information Address Line 1 Address Line 2 City State/Province, and country if not U.S.A. Zip or Postal Code Phone * Email * What best describes your current status? Faculty Postdoc Graduate Student Undergraduate Student Researcher (but none of above) K-12 Educator K-12 Student Professional Staff MLBS Staff Artist Guest of a Resident or Family Member Other... What best describes your current status? Other... Proposed Research or Activity This is an application to: Conduct research Use the Station for some other purpose like a visiting group or a class Title of Project or Activity (will be used in MLBS reports and public information) Start Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20162017201820192020 Expected End Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year201620172018201920202021202220232024202520262027 Description of Proposed Work: Paste in a short proposal (bullet / outline format is fine). Please include: A brief description of the project and goals. Procedures/manipulations/methodologies that will be adopted, with special attention to long-term impacts on the land or biota of MLBS and surrounding area and potential conflicts with other field work. GPS coordinates if available. Timeline: Duration of project activities at MLBS from inception, what dates are planned this year, and will the project potentially run into future years. Estimation of lab or group size (co-PIs, assistants, technicians, employees, etc.) Proposed Research or Activity Please identify facilities/equipment/space requirements Will your work involve non-local organisms? No Yes Will your work involve vertebrate animals? No Yes Use of vertebrates requires special advanced approval. Please see: Use of Vertebrate Animals in Research and Teaching. All animal users and handlers are responsible for knowing and satisfying all state, federal, and institutional requirements. This includes all home institution and University of Virginia IACUC and Occupational Health requirements. List sources of support for your work Is your work supported by the NSF? No Yes, Division and Program... Is your work supported by the NSF? Yes, Division and Program... Research Support Request (optional): MLBS has some funds to help cover costs of doing research for graduate students and early career faculty. If you wish to be considered for one of these awards please provide a brief budget (e.g. station fees and research expenses) and information on any other current or pending support. Review of applications for support begins March 15. Research Support Help Us How did you learn about Mountain Lake? Check all that apply Brochure, Poster or Display made available through my school Brochure sent directly to me Web site Current or former Mountain Lake student Current or former Mountain Lake faculty Instructor or Advisor On-line database or student opportunities clearing house Other... How did you learn about Mountain Lake? Check all that apply Other... Please review your application before submitting. Thank you very much!