NODE

APPLICATION FORM
[Datum auswählen]

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Please submit this application form to office@omilab.org.
In case of any questions please contact her us the same e‐mail address.

Institution Name

Name of Department/
Research Group/Centre

Website

Contact Person (please include information below)

First Name

Last Name

Academic Title

Position

Address

E‐Mail

Phone

PROFILE OF THE APPLYING ORGANIZATION/ENTITY

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Describe shortly the profile of the organizational entity and the institution it belongs to with regards
to its objectives and activities. Provide any additional information you deem necessary.

1 OMILAB NPO, www.omilab.org

Lützowufer 1, 10785 Berlin, Germany
 FOCUS OF YOUR OMILAB NODE

[Should you wish to remove this field before submitting the application, mark the field and press BLANK].
Please state shortly the domain as well as the specific topic (if you have one in mind) that you would
like to address with your OMiLAB.

MOTIVATION TO BECOME AN OMILAB NODE

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Please shortly state your motivation to become an OMiLAB Node.

INTENDED CONFIGURATION OF YOUR OMILAB NODE

[Should you wish to remove this field before submitting the application, mark the field and press BLANK].
Tell us what configuration (for more details see document “How to establish an OMiLAB”) of the
OMiLAB Node you have chosen for yourself. Let us know here also which kind of information will be
helpful to you to get started with your node. We have a collection of materials, which we are happy
to make available to you.

ACTIVITIES PLANNED

Research/Educational/Other Activities
[Should you wish to remove this field before submitting the application, mark the field and press BLANK].
Please provide a list of activities you intend to carry out in your OMiLAB node.

ANY OTHER INFORMATION YOU DEEM USEFUL

2 OMILAB NPO, www.omilab.org

Lützowufer 1, 10785 Berlin, Germany