Lunar and meteorite samples loan scheme application form

Please note that the Lunar Loan kits are fully booked until the end of July 2020.

Please complete ALL sections of this form, fields marked with a * are mandatory.

Security Rules

This form will not fully display until you have agreed to the security rules.

By checking the box you are confirming that you have read and understood the security rules and regulations in relation to this scheme.

Your Details

*Title:

*Forename(s):

*Surname:

*Institution:

*Address Line 1:

*Address Line 2:

*Town/City:

*Postcode:

*Telephone number:

*Email address:

Co-official's Details

*Title:

*Forename(s):

*Surname:

*Institution:

*Address Line 1:

*Address Line 2:

*Town/City:

*Postcode:

*Telephone number:

*Email address:

Loan details

*Q1. What is the purpose of the loan?
(If you are borrowing the samples on behalf of a university, please confirm that you will only be using the samples with university aged students)

Q2. Date the samples are required (normally Monday - Friday inclusive)

* First choice:

* Second choice:

*Q3. How did you hear about the scheme?

*Q4. Have you borrowed the moon rocks before at this location?

*Q5. Have you been the official or co-official of a previous lunar and meteorite loan at this location?

Security during the loan period

*Q6. Please provide details of the security measures you have in place for protecting the samples upon arrival at your institution:

*Q7. What type of safe or secure storage do you propose to use?

*Q8. Where is the above located?

*Q9. Who holds the keys or has the combination for the above?

*Q10. What are the security arrangements for the building in which the samples will be stored?

Q11. What are the security arrangements for the building at weekends (if applicable)?

*Q12. How do you propose to ensure the security of the samples while they are in use?

Please estimate how many people will see the samples

Data Protection

The personal information you supply in this form will be managed by STFC (who are part of UK Research and Innovation) in accordance with the provisions of the General Data Protection Regulation (GDPR) and Freedom of Information.

We will not use your information for any other purpose, other than in relation to the scheme. More information about data privacy.

*Q13. Would you like STFC to issue a press release about the samples to your local media and send a copy to you?

Last updated: 20 January 2020