Please submit a separate form for each project.

BEFORE FILLING OUT THIS FORM, PLEASE READ THE COVID RESEARCH RELATED GUIDELINES FOR MGH.

Principal Investigator *

PI Email address *

Site Responsible Investigator

If same as PI, enter “PI”

Site Investigator Email

Imager Project Code *

Delete the following users

Add the following users

Specify the Martinos Center username for each.

Current IRB/IACUC protocol number(s), title and protocol PI *

Scanner *

Hours per week needed *

Technologist support needed? *

Will physiological monitors, INVIVO or AD instruments, AVOTECH headphones be used? *

Other Requirements

(specific Bay, etc.), account changes (fund number), or other comments.

COVID-19 Attestation *

Scheduling Policy Attestation *