Fermilab Technology Applications Program



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Fermilab Technology Applications Program


Expression of Interest


Project/Proposal Name:








Company/Institution




Street Address


Phone

Company URL


City, State, Zip Code


Fax

Contact Person







Name

Street Address

Phone



Title

City, State, Zip Code

Email

Do you wish to have information in this EOI treated as proprietary? Yes No (please circle one)

Provide additional comments if desired.



Comments:




Is your interest in the Fermilab Technology Applications Program “general” in nature or do you have a specific project in mind? If you wish to submit information on more than one project, please submit one EOI form per project.

If you or others you know would like to be added to the IARC Email Distribution List for future informational emails, please list their names and email addresses below:







If you want to express an interest in a specific project, please provide the information requested in the questions below, using one EOI form per project.

1. Briefly describe the project or work you would like to do at the Illinois Accelerator Research Center or with other facilities at Fermilab.




2. Please provide an explanation of the Intellectual Property or the product to be created, the benefits of the work to the Department Of Energy, the State of Illinois, and the public.




3. Describe roughly the resources required by the project (floor space, AC power, radiofrequency power, or cryogenics needs, FNAL personnel requests, office space requirements, radiation shielding requirements, other support required.)




  1. Indicate the approximate funding required and proposed funding sources for various phases of the project. (Materials, Services, and Labor)




  1. What is the approximate start date for your project?




  1. What is the approximate duration of each phase of this project?




4. Will this work lead to Intellectual Property owned by or a product or service provided by a U.S. or Illinois Company? Please elaborate.




5. For educational proposals, please describe the need and benefits of the proposed program.




6. Will any non-U.S. Company or Nationals be involved in the proposed work?



Please email the completed form to IARC director Bob Kephart <Kephart@fnal.gov>.


For more information on IARC see http://iarc.fnal.gov/


Rev.01/13/2012




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