Application Life Imaging Center (Version 2026)

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

Instruction Notes:

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

Some sections must be filled out and signed by the project leader, others by the applicant.

After each page, your input data can be saved and continued at a later time.

A summary is distributed via PDF to you by email.

Bring this as print out with the appropriate signatures with you when you visit the LIC the first time for your introduction.

Page 1 of 6 - Personal Information (Applicant)

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Date (day of registration) Date (day of registration) / MM / DD YYYY
Name (Applicant) Name (Applicant) Title First Last Suffix
Please indicate your full name.
Gender

Gender male female diverse do not want to answer
Your > User ID < of your "My Account" - University (i.e mm1123)

If you have no USER ID please sign in XX/1111

More information: https://myaccount.uni-freiburg.de/uadmin/login
Uni-Card Number (account number at your University-Card: Employee Card / Students 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.
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.
Preferred Language

Preferred Language English German
Affiliation

Please indicate your affiliation.
Affiliation (Other)
Must be between 5 and 100 characters. Currently Entered: 0 characters.
Please indicate your affiliation.
Name of Institution

Please indicate the name of your home institution.
Phone lab (only numbers without hyphens, parentheses, or empty spaces)
Attention !! Please give us only your work (lab) address, no private address!!
Lab Street Address

LAB ADDRESS::
Please indicate your street address and number.
Postal / Zip Code

BILLING ADDRESS:
Please indicate your postal / zip code.
City

BILLING ADDRESS:
Please indicate your city.
Company
Must be between 5 and 100 characters. Currently Entered: 0 characters.
Please indicate your company.
Faculty (University of Freiburg)

Please indicate the faculty within Freiburg University.
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)

Please indicate your department within the clinics.
Department (Internal Medicine)

Please indicate your department within the clinics.
Department (Mental Illnesses)

Please indicate your department within the clinics.
Department (Pediatrics and Adolescent Medicine)

Please indicate your department within the clinics.
Department (Radiological Diagnostics and Therapy)

Please indicate your department within the clinics.
Department (Surgery)

Please indicate your department within the clinics.
Institute (Faculty of Medicine)

Please indicate your institute within the faculty of medicine of Freiburg University.
Department (Faculty of Mathematics and Physics)

Please indicate your Department.
Institute (Faculty of Chemistry and Pharmacy)

Please indicate your institute.
Institute (Faculty of Biology)

Please indicate your institute within the Faculty of Biology.
Department (Faculty of Engineering)

Please indicate your Department.
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
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.

Application Life Imaging Center (Version 2026)

Application Life Imaging Center (Version 2026)

Page 1 of 6 - Personal Information (Applicant)

Attention !! Please give us only your work (lab) address, no private address!!