CHSLT submit a request form

CHSLT laboratories Student Registration Form

Fill out the form carefully for registration
Student Name*

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Contact Number*

Area CodePhone Number
WPI E-mail*
WPI ID number*
You are using the equipment for:*
Why the need of this equipment is necessary for your research/course?*
Should be Empty:

CHSLT laboratories Student Registration Form