Fields Institute Office Request

1. Please enter your first and last names and preferred email address. *This question is required.

First Name

Last Name

Email Address

You have requested a shared office space at the Fields Institute. Space permitting, we are able to assign one if you intend to be here for 10 or more days in conjunction with a program. Would you still like an office at the Fields Institute? Please request space as early as possible, ideally no later than two to three months before your intended stay.

*This question is required.

3. What date do you intend to arrive at the Fields Institute? *This question is required. Please give us your best estimate. We understand that this may change. Date is collected in mm/dd/yyyy format. This question requires a valid date format of MM/DD/YYYY.

calendar

3. What date do you intend to depart the Fields Institute? *This question is required. Date is collected in mm/dd/yyyy format. This question requires a valid date format of MM/DD/YYYY.

calendar

3. Computing Equipment
Visitors generally bring their own computers/devices to use while at Fields. Fields does have a small number of desktop computers for visitor use. These employ a Linux operating system and have a small number of preloaded applications. Please indicate if you would like to request a visitor desktop computer. *This question is required.

Please indicate if you would like to be assigned to a desk that has either a Fields computer or a Fields monitor for use with your own device. Please note that such desks are limited, and while we will do our best to accommodate your request, we cannot guarantee it, as it will depend on how many people make the request. If you have other IT needs or wish to borrow other types of equipment, please contact Johann Taylor upon your arrival. He can be found in office 324 or you can send e-mail to sysadmin@fieldsinstitute.ca.

4. What Institution and/or Organization will you be affiliated with during your stay at the Fields Institute? *This question is required.

4. What is your occupational status? *This question is required.

4. Gender
(used for statistical reporting purposes in order to improve access to resources): *This question is required.

Please enter an 'other' value for this selection.

4. Why are you visiting the Institute? *This question is required.If you are unsure of the category, please follow the link to clarify if the category applies to your situation.

Please enter an 'other' value for this selection.

4. The Fields Institute lists current visiting members on our webpage under People and Contacts. We would like to provide you the opportunity to link to your own research webpage. Would you like to add a research webpage link to your name? *This question is required.

4. Please provide the link to your research webpage.

4. Are you affiliated with a Fields Institute Principal Sponsoring University (PSU)? *This question is required.

4. Which one? *This question is required.

4. Please provide an emergency contact name for our use during your visit at the Fields Institute. *This question is required.

4. Please provide a phone number for your emergency contact. *This question is required. This person can be a local or international contact.

4. Please provide an email address for your emergency contact. *This question is required. This question requires a valid email address.

4. I no longer need an office because:

Please enter an 'other' value for this selection.