Experimental Results Release Form
Please complete this form to authorize the release of experimental results and provide necessary details.
Participant Full Name
*
First Name
Last Name
Participant Email Address
*
example@example.com
Participant Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Affiliation/Organization
Experiment/Project Title
*
Experiment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Brief Description of Experiment
*
Description of Results to be Released
*
Recipient Name or Organization
*
Purpose of Results Release
*
Preferred Method of Release
*
Email
Physical Copy
Online Portal
Other
Are there any restrictions or conditions for the use of the released results?
*
No restrictions
Yes, specify below
If yes, please specify the restrictions or conditions
Signature of Participant/Authorized Person
*
Submit Release
Submit Release
Should be Empty: