School of Chemistry Honorary/Visiting/Affiliate Status Registration Form The person detailed below will be displayed on the University Staff A Z and is entitled – to a University ID card, use of the Library and an IT account if requested. Honorary Category: Visiting Affiliate (Delete as Senior Research Fellow appropriate) Research Fellow Research Associate Type of Registration New / Continuation (Delete as appropriate) Personal Details Title: Surname: Forename: Known as: Gender: Date of birth: Telephone: Personal email address: Correspondence Address: Post Code: Degree[state name of awarding institution(s) and date of award(s)] Person number (if previously registered): Post Details College/US: School/RI/Service: Role Title: Detail nature of role and contribution: Start date: Expected end date: I hereby certify that the information is complete and correct. I will comply with any relevant regulations to my role, including the University IT regulations if IT is provided Date Applicant’s Signature AUTHORISED BY SCHOOL OF CHEMISTRY Professor Graeme Cooke, Head of School - Chemistry Authorised by: Signed Date . Updated Chemistry 6/9/16 – –
School of Chemistry Honorary/Visiting/Affiliate Status Registration Form The person detailed below will be displayed on the University Staff A – Z and is entitled to a University ID card, use of the Library and an IT account if requested. Category: (Delete as appropriate) Honorary Senior Research Fellow Research Fellow Research Associate Visiting Affiliate Type of Registration (Delete as appropriate) New / Continuation Personal Details Title: Surname: Forename: Known as: Gender: Date of birth: Telephone: Personal email address: Correspondence Address: Post Code: Degree[state name of awarding institution(s) and date of award(s)] Person number (if previously registered): Post Details College/US: School/RI/Service: Role Title: Detail nature of role and contribution: Start date: Expected end date: I hereby certify that the information is complete and correct. I will comply with any relevant regulations to my role, including the University IT regulations if IT is provided Applicant’s Signature Date AUTHORISED BY SCHOOL OF CHEMISTRY Authorised by: Professor Graeme Cooke, Head of School - Chemistry Signed Date . Updated – Chemistry – 6/9/16