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The University of Alabama 2013 Application for Summer Undergraduate Research Participation Program in Chemistry

May 26 - August 2, 2013

To apply for the 2013 Summer Undergraduate Research Participation (SURP) Program at the University of Alabama, fill out and submit the following form. You will also need to send a letter stating your career objectives and arrange for two letters of reference to sent on your behalf.

If your browser does not support forms or your would rather mail in your application you can download a PDF version of the application form (requires Adobe Acrobat). You will also need to download the letter of reference form to give you the people writing recommendation letters for you.

Contact Information:

First Name: Last Name:
Phone Number (present): Ext. Phone Number (permanent): Ext.
Address (present) Address (permanent):
:email Address: Date of Birth (dd/mm/yy):
Social Security #: Citizenship:

Academic Information:

College(s) and University(ies) attended with dates:

Academic Status:
Expected Graduation Date (mm/yyyy):
Overall GPA (i.e. 3.8/4.0): Chem GPA:

Chemistry Courses

General Chemistry I General Chemistry II
Organic Chemistry I Organic Chemistry II
Organic Chemistry Lab Analytical Chemistry
Physical Chemistry I Physical Chemistry II

Other Chemistry Course:

 Other Chemistry Course

Other Science and Mathematics Courses 

Physics I Physics II
Mathematics I Mathematics II
Mathematics III Mathematics IV
Biology I Biology II
Other Science
 Other Science
Language:

Earliest date you could begin research:
Do you plan to attend graduate school? Yes No
If "yes" in chemistry , biochemistry , or other?
Does medical school figure in your plans? Yes No

REFERENCES:

Please give the Names, Titles, Addresses and (if possible) Phone Numbers of two persons Whom you have asked to write Letters of Recommendation.

Reference #1 Reference #2
Name: Name
Address Address
Phone Number Ext. Phone Number Ex.

Download the Letter of Reference form and give a copy to each person who will be writing a letter of recommendation.

UNDERGRADUATE RESEARCH PROJECTS

Click the "Research Projects" button for a list of projects. Indicate your top four (or more) choices of research projects or areas by number in the boxes below.

First Choice Second Choice Third Choice
Fourth Choice
Other Choices

Please note that information you provide in this application may be used for statistical analysis that may help ensure the continued growth and vitality of summer research programs for undergraduate students. All information provided will remain confidential. If you do not wish to share your information, please click "No" below.

APPLICATION SHOULD BE SUBMITTED BY February 28, 2013.

In addition to submission of this form, you should send a one-page letter stating your career goals. Your letter should indicate how you think participation in this program will assist you in attaining these goals. This letter should be recieved at the following address by the above deadline.

ATTN: Dr. John Vincent
Summer Undergraduate Research Program
Department of Chemistry
The University of Alabama
Tuscaloosa, AL 35487-0336

You will also need to give a copy of the following form to each person who will be writing letters of reference for you. You should give your references plenty of time to write a thoughtful letter. These letters must be received by the application deadline.Reference Form
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