Change of personal user data at Life Imaging Center

Address:
Albert-Ludwigs University
Life Imaging Center (LIC)
Habsburgerstr. 49
79104 Freiburg im Breisgau

2nd Address :
Schänzlestr. 18
79104 Freiburg im Breisgau

e-mail: lic@imaging.uni-freiburg.de

Notes:
Fields indicated by a red asterisk are required and must be completed in order to proceed.

Page 1 of 5 - Personal Information (Applicant)

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Date (day of changing details) Date (day of changing details) / MM / DD YYYY
Name (Applicant) Name (Applicant) Title First Last Suffix
Please indicate your full name.
E-Mail Address

Confirm E-Mail Address

Please indicate your professional E-Mail address. Please check that your E-Mail address is correct. We will use your E-Mail address for all communication regarding this event.
Change of

Change of Email Phone Position User-ID Unicard number Affiliation Safety class Contract Project
Old E-Mail Address
Phone lab (only numbers without hyphens, parentheses, or empty spaces)
My account USER-ID (i.e mm1123)
If you have no USER ID please sign in XX/1111
Uni-Card Number (account number at your Uni-Card)
If you have no Uni-Card please sign in XX/1111

Application for Uni-Card:

You’ll find information about the UniCard for students and staff members of the University of Freiburg and other UniCard users.

https://www.unicard.uni-freiburg.de
Position

Please indicate your current position.
Position (Other)
Must be between 5 and 100 characters. Currently Entered: 0 characters.
Please indicate your current position.
Affiliation

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Affiliation (Other)
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Please indicate your affiliation.
Name of Institution

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Company
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Please indicate your company.
Faculty (University of Freiburg)

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Central Research Institut (University of Freiburg)

Please indicate the central research unit within Freiburg University.
Central Research Institut (Other)
Must be between 5 and 100 characters. Currently Entered: 0 characters.
Please indicate your central Research Institute.
Clinic (Medical Center - University)

Please indicate your clinic within the Medical Center - University.
Institute (Medical Center - University)
Medical Interdisciplinary Centers (Medical Center - University)

Please indicate your medical interdisciplinary center within the Medical Center - University.
Department (Dental, Oral and Jaw Medicine)

Please indicate your department within the clinics.
Department (Heart Center, University of Freiburg)

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Department (Internal Medicine)

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Department (Mental Illnesses)

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Department (Pediatrics and Adolescent Medicine)

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Department (Radiological Diagnostics and Therapy)

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Department (Surgery)

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Institute (Faculty of Medicine)

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Department (Faculty of Mathematics and Physics)

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Institute (Faculty of Chemistry and Pharmacy)

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Institute (Faculty of Biology)

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Department (Faculty of Engineering)

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Department (Faculty of Biology)

Please indicate your department within the Faculty of Biology.
Cluster of Excellence (University of Freiburg)

Please indicate your cluster of excellence within Freiburg University.
Cluster of Excellence University of Freiburg (Other)
Must be between 5 and 100 characters. Currently Entered: 0 characters.
Please indicate your cluster of excellence within Freiburg University.
Name of your Work Group / Group Leader Name of your Work Group / Group Leader Title First Last Suffix
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Change of personal user data at Life Imaging Center

Change of personal user data at Life Imaging Center

Page 1 of 5 - Personal Information (Applicant)