New eLab Account Request Form

Please complete this form to request a new eLab account. After your request is received, it will be reviewed by the UNMC Research IT Office (RITO), who will reach out regarding your request.

If you have questions about eLab, please contact RITO (rito@unmc.edu).

First Name:		Last Name:
UNMC Email:

Accounts must be assigned to a UNMC email address!
Please enter your UNMC email address.

Primary Role:

* must provide value

Please provide the contact details for your primary Supervisor (If you are PI please add Chair or Dean):

Supervisor Name:

Supervisor Email:

Primary College, Institute, or Unit:

* must provide value

Which Department/Division in
______?

* must provide value

Which Department in College of Medicine?

* must provide value

Which Division of ______?

* must provide value

Other College/Institute/Unit - Please Describe:

* must provide value

Other CoM Department - Please Describe:

* must provide value

Each eLab account will be charged for an annual fee ( $115/user account) for the usage in every fiscal year, Please provide the valid Cost Center Number here ( no dash or space) :
* Please note each eLab account you added later to your group will be billed for this fee as well.

* must provide value

At this time, two of the eLabNext modules are availible at UNMC:

eLab Journal — an all-in-one Electronic Lab Notebook
eLab Inventory — an advanced inventory management system

Which of the following eLab modules do you plan to use in your laboratory?
(select all that apply)

* must provide value

eLab Journal

eLab Inventory

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