Micro and Nano Fabrication Clean Room







































Rensselaer Polytechnic Institute

Service Center Funding Authorization Form

CIE Micro  and Nano Fabrication Clean Room
This form authorizes CIE Micro and Nano Fabrication Clean Room to automatically charge the fund(s) below for services provided

**Please note that your signature authorizes us to give an MNCR Access Card to the user.  You , as the authorizer, are responsible for all fees charged to that card until the card is returned to Dave King.  When you no longer support the user, you agree to collect and return the card.




Authorizer Information
 (Please Print)
 User Information

Department:



User Name:

 

 

Name:



Project Title:

 

 

RPI Address:

 

 

 





 

Phone:

 

 

 


 

 

 

 

Fax:

 

 

 


User's Phone/Fax/Email:

 

E-mail:


 

 


 

 


 

FOAPA Information

Fund

Org

Account

Program

Activity

End Date (1)

Home ORG (2)

MUST BE COMPLETED

 

 


 

 

 

 


 

 


 

 

 

 


 

 


 

 

 

 


 

 


 

 

 

 

(1)   If using a restricted (A, B, or F) fund, an end date and a home organization must be provided.
(2)   The home org. will be charged if a research fund is overexpended or if charges are past the project end date.

Please send a monthly statement of services:

Yes


No






Circle One












Funding Authorization Signature:


 

 



PI Signature for Research funds





                                                                                                                                                                                               

Funding Authorization Printed Name:

 

Financial Manager Signature:

 

Financial Manager Printed Name:

 

Notes:                                                                                                                                 

                                                                                                                                            

                                                                                                                                             

Please return to Dave King, General Manager, Micro and Nano Fabrication Clean Room
CII Room 4167 Rensselaer Polytechnic Institute, 110 8th St., Troy, NY  12180










MNCR Staff


Clean Room
Manager
David King
(518)-276-2938
kingdc@rpi.edu
Senior Applications
Engineer
David Frey
(518)-276-3323
freym2@rpi.edu
Process
Engineer
Bryant Colwill
(518)-276-3946
colwib2@rpi.edu
Equipment
Engineer
John Barthel
(518)- 276-2975
barthj@rpi.edu
Equipment
Engineer
Kent Way
(518)- 276-3317
wayk2@rpi.edu