Power Area: Student Room Access * NAME First Last * UIN 9 digit number * NETID * GRAD/UNDERGRAD CHOOSE ONE GRAD STUDENT (POWER & ENERGY) GRAD STUDENT (OTHER) UNDERGRAD STUDENT (PAID) UNDERGRAD STUDENT (NON-PAID) * GRADUATION DATE * STATUS CHOOSE ONE RA RA/TA TA LAB WORKER SENIOR DESIGN SENIOR THESIS OTHER (SPECIFY IN NOTE SECTION) * ADVISOR CHOOSE ONE PROF. BANERJEE PROF. BOSE PROF. DOMINGUEZ-GARCIA PROF. GROSS PROF. HARAN PROF. KREIN PROF. SAUER PROF. STILLWELL PROF. ZHANG OTHER OTHER ADVISOR / SUPERVISOR / TA * ECE STUDENT YES NO Proximity Card Status * ECE BUILDING ACCESS Yes No ROOM ACCESS NO ACCESS 4030, 4032, 4038, 4068, 4076 - Primarily for Graduate Students 4038, 4068 - Graduate Areas 4038 - West Graduate Area 4068 - East Graduate Area Undergraduates will have to be approved access to the rooms. LAB ACCESS 4020 4024 4026 4076 Kevin Colravy will approve access. * EMAIL ADDRESS Please use your Illinois email. * PHONE NUMBER 1. ARE YOU FILLING THIS FORM OUT FOR SOMEBODY ELSE? Yes No 2. IF SO, WHAT IS YOUR NAME AND ASSOCIATION TO THIS STUDENT? LAB SAFETY TRAINING CERTIFICATE Max file size is 67 MB. NOTES