Request/experiment title:

First name:

Last name:

Phone #:

Phone Ext:

Fax #:

Mobile #:

Email address:

Institution:

Department:

Address:

City:

State:

ZIP:

Country:

Your role:

Additional PIs

Short name:

Enter an acronym for the experiment

Long name:

Enter the full name of the experiment

Date equipment will ship from CTEMPs:

Month:   Day:   Year:

Date equipment will return to CTEMPs:

Month:   Day:   Year:

Experiment longitude:

Use + for East, - for West, and decimal notation. Example W 105º30'30" would be entered as -105.508333

Experiment latitude:

Use + for North, - for South, and decimal notation. Example S 35º30'30" would be entered as -35.508333

Experiment description (limit 500 words):

Environment:

Additional comments (limit 500 words):

Funding agency:

Is the experiment funded?

Yes      No

Funding program:

Proposal number:

Funding comments (limit 500 words):

Distributed temperature sensor (DTS) type:

DTS quantity:

Wireless sensor quantity:

Wireless sensors check:

Wind speed
Precipitation
RH/T
Soil moisture
Solar radiation
Other (please specify below)

Fiber-optic cable quantity (in meters):

0 denotes you will purchase separately

Fiber-optic cable type:

Data transmission:

Describe wireless/LAN service:

Power supply:

Solar
AC Power

  Note: Deep discharge batteries must be furnished by PI

Describe power environment:

Do you need calibration baths and an independent temperature logger?
Yes      No      I don't know (please describe below)

Do you require CTEMPs field support?
Yes (please describe below)      No