{"id":3368,"date":"2025-08-19T14:53:08","date_gmt":"2025-08-19T18:53:08","guid":{"rendered":"https:\/\/quantum.ncsu.edu\/ibm-quantum\/?page_id=3368"},"modified":"2025-08-19T14:53:09","modified_gmt":"2025-08-19T18:53:09","slug":"nc-state-student-qic-account-request-form","status":"publish","type":"page","link":"https:\/\/quantum.ncsu.edu\/ibm-quantum\/nc-state-student-qic-account-request-form\/","title":{"rendered":"NC&#160;State Student QIC Account Request Form"},"content":{"rendered":"\n\n\n\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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data-form-theme='legacy' data-form-index='0' id='gform_wrapper_8' style='display:none'><div id='gf_8' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_8'  action='\/ibm-quantum\/wp-json\/wp\/v2\/pages\/3368\/#gf_8' data-formid='8' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_8_29\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_29'>Comments<\/label><div class='ginput_container'><input name='input_29' id='input_8_29' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_8_29'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_8_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have an existing QIC Account?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_8_22'>\n\t\t\t<li class='gchoice gchoice_8_22_0'>\n\t\t\t\t<input name='input_22' type='radio' value='No' checked='checked' id='choice_8_22_0'    \/>\n\t\t\t\t<label for='choice_8_22_0' id='label_8_22_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_8_22_1'>\n\t\t\t\t<input name='input_22' type='radio' value='Yes'  id='choice_8_22_1'    \/>\n\t\t\t\t<label for='choice_8_22_1' id='label_8_22_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_8_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_8_1'>\n                            \n                            <span id='input_8_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_8_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_8_1_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.4' id='input_8_1_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_8_1_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_8_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_8_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_8_2\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_2'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_2' id='input_8_2' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_8_2_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_8_2_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_8_2' class='gform_hidden' value='https:\/\/quantum.ncsu.edu\/ibm-quantum\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_8_19\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_19'>Unity ID<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_8_19' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_8_4\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_8_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_8_4_1_container' >\n                                        <input type='text' name='input_4.1' id='input_8_4_1' value=''    aria-required='true'    \/>\n                                        <label for='input_8_4_1' id='input_8_4_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_8_4_2_container' >\n                                        <input type='text' name='input_4.2' id='input_8_4_2' value=''     aria-required='false'   \/>\n                                        <label for='input_8_4_2' id='input_8_4_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_8_4_3_container' >\n                                    <input type='text' name='input_4.3' id='input_8_4_3' value=''    aria-required='true'    \/>\n                                    <label for='input_8_4_3' id='input_8_4_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_8_4_4_container' >\n                                        <select name='input_4.4' id='input_8_4_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_8_4_4' id='input_8_4_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_8_4_5_container' >\n                                    <input type='text' name='input_4.5' id='input_8_4_5' value=''    aria-required='true'    \/>\n                                    <label for='input_8_4_5' id='input_8_4_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_8_4_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_8_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_7'>Citizenship<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_8_7' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_8_8\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_8'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_8' id='input_8_8' type='email' value='' class='medium'   placeholder='NC State Email Required' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_8_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_5'>Employer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_8_5' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_8_6\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_6'>NC State University Affiliation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_8_6' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Other' selected='selected'>Other<\/option><option value='Faculty' >Faculty<\/option><option value='Staff' >Staff<\/option><option value='Grad Student' >Grad Student<\/option><option value='Undergrad Student' >Undergrad Student<\/option><\/select><\/div><\/li><li id=\"field_8_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_17'>Major<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_8_17' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_8_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_9'>If you answered student, please state your principal investigator(PI) that your are working under, whose work will incorporate the use of quantum computing<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_8_9' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_8_16\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_16'>Project requesting access for<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_16' id='input_8_16' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Asymmetry of CNOT Gate Operations (Stancil)' >Asymmetry of CNOT Gate Operations (Stancil)<\/option><option value='Dynamic Runtime Assertions for Quantum Computing (Zhou)' >Dynamic Runtime Assertions for Quantum Computing (Zhou)<\/option><option value='ECE792 (Zhou)' >ECE792 (Zhou)<\/option><option value='Ising Model Simulation (Stancil)' >Ising Model Simulation (Stancil)<\/option><option value='NCSU - Impact of Noise and Error mitigation (Dreher)' >NCSU &#8211; Impact of Noise and Error mitigation (Dreher)<\/option><option value='NCSU - Noise experiment (Mueller)' >NCSU &#8211; Noise experiment (Mueller)<\/option><option value='NCSU - Q53 Testing (Mueller)' >NCSU &#8211; Q53 Testing (Mueller)<\/option><option value='NCSU - Scattering simulations of the One dimension Quantum Ising Model (Dreher)' >NCSU &#8211; Scattering simulations of the One dimension Quantum Ising Model (Dreher)<\/option><option value='Physics of spin (Kemper)' >Physics of spin (Kemper)<\/option><option value='Practical Quantum Chemistry on Quantum Computers (Jakubikova)' >Practical Quantum Chemistry on Quantum Computers (Jakubikova)<\/option><option value='Quantum Architectures (Byrd)' >Quantum Architectures (Byrd)<\/option><option value='Quantum Drug Discovery (Stancil)' >Quantum Drug Discovery (Stancil)<\/option><option value='Quantum Compiler Optimization (Zhou)' >Quantum Compiler Optimization (Zhou)<\/option><option value='Quantum error modeling (Zhou)' >Quantum error modeling (Zhou)<\/option><option value='Quantum Networking and Distributed Quantum Computing (Yu)' >Quantum Networking and Distributed Quantum Computing (Yu)<\/option><option value='Recycling Garbage Qubits for Enhancing Resource Utilization (RECQ)' >Recycling Garbage Qubits for Enhancing Resource Utilization (RECQ)<\/option><option value='VLSI CAD tools  (Franzon)' >VLSI CAD tools  (Franzon)<\/option><option value='Symmetry-adapted quantum signal processing for spin chemistry (Liu)' >Symmetry-adapted quantum signal processing for spin chemistry (Liu)<\/option><option value='Quantum Computing based FEA for structure and and materials design (Xiong)' >Quantum Computing based FEA for structure and and materials design (Xiong)<\/option><option value='Quantum Machine Leaning (Kais)' >Quantum Machine Leaning (Kais)<\/option><option value='CSC\/ECE 569 (Mueller)' >CSC\/ECE 569 (Mueller)<\/option><option value='New Project' >New Project<\/option><\/select><\/div><\/li><li id=\"field_8_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_28'>New Project Name<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_8_28' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_8_21\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >By checking this box you are agreeing to the terms and conditions of use for a QIC Account found here<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_8_21'><a target=\"_blank\" href=\"https:\/\/docs.google.com\/document\/d\/1Ot9YZHALMeNOZzf7ywnoDa6Sf_whR0TnETrkijpv8KI\/edit#\">Terms and Conditions<\/a><\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_8_21'><li class='gchoice gchoice_8_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='I Agree'  id='choice_8_21_1'   aria-describedby=\"gfield_description_8_21\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_8_21_1' id='label_8_21_1' 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