BioRender Premium Software License Request Form

Please complete this form to request a new BioRender Premium Software License. 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 BioRender, please contact RITO (rito@unmc.edu).

USER DETAILS

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

Role (other), please describe:

* must provide value

Please provide the contact details for your primary Supervisor, PI, or Mentor:

Name:

* must provide value

Email:

* must provide value

Role (in relation to you):

* must provide value

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

Are you approved by your Department Chair or Admin or Center Admin to get BioRender License paid by Department/Center?

* must provide value

Yes

No, I am paying by myself

reset

If yes, please select the Department:

Please note: Your department is not on this list means that your department hasn't responded to RITO's invitations for purchasing Biorender licenses for your department researchers. We encourage you to talk with your department Chair on considering Biorender licenses bulk purchase option from RITO.

* must provide value

BioRender account annual fee ( $122/year/user) will be charged for the usage between July,2023 to June 2024( No Proration), Please provide the valid Cost Center Number here ( no dash or space) :

* must provide value

Please list the bill contact's UNMC email:

* must provide value

BIORENDER ACCOUNT - SECONDARY CONTACT INFORMATION

It is best practice, and now required, to designate a separate person to be your "secondary contact" for each BioRender account. This can be your supervisor, mentor, administrator, dean/director/chair/chief, or a colleague/collaborator, and must have a UNMC email address. This designee does not need to have a BioRender account, nor will they need to have access to your files/folders.
This information would only be used in the case of an emergency, so that someone familiar with your projects or data could help assess. Please provide details on your secondary contact below.

Designate your Secondary Contact

NOTE: This must be someone other than yourself.

Role of Secondary Contact (in relation to you):

* must provide value

Name of Secondary Contact:

* must provide value

UNMC Email of Secondary Contact:

* must provide value

You cannot be your own secondary contact.
Please select someone other than yourself (i.e. your mentor/supervisor/etc).

Secondary contact must have a UNMC email address!
Please select an individual from UNMC and provide their email address.

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