Dosimetry Application Form UWM Personal Dosimetry Application Form Personal Dosimeter form for students/researchers working with X-ray devices or Radioactive Materials. Name(Required) First Middle Last Are you over the age of 18?(Required) Yes No Date of Birth(Required) MM slash DD slash YYYY Sex Assigned at Birth(Required)FemaleMaleEmail(Required) I will work with(Required) X-Ray Devices Radioactive Materials Primary Investigator:(Required)I was previously badged at:(Required) UW-Milwaukee Current or Previous Employer None of these; I was never previously badged Check all that applyBy signing this form, I attest to the following:Employee Signature:(Required)Name may be typed into the signature field.Signature Date:(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Comments - If you have been previously badged, please give employer name and contact phone/email so previous dosimetry history can be acquired.