2023-2024 – IMPRESS Application – Open to University of Alabama Students Only Your Contact InformationName* First Last Date of Birth* MM slash DD slash YYYY CWID Race/EthnicityWhiteAsianAfrican AmericanHispanicNative AmericanPacific IslanderOtherSelect all that applyGender* Male Female Status*Only US Citizens or permanent residents are permitted in the program and, therefore, eligible to apply. U.S. Citizen Permanent Resident Do you have a passport that is valid until 1/31/2025? Yes No Do you speak Spanish? Yes No If yes, what level of proficiency? Have you ever traveled abroad? Yes No If yes, which country(ies) and when? Are you a first-generation college student?A first-generation college student is defined as a student whose parent(s)/legal guardian(s) have not completed a bachelor's degree. This means that you are the first person in your family to attend a four-year college/university to attain a bachelor's degree. Yes No Have you passed CHE 412/MTE 412? Yes No If no, are you willing and able to take this course in Spring 2024? Yes No Do you currently do undergraduate research at UA? Yes No If YES, which labs(s) and department(s)? How many semesters? Any other research experience (e.g., REU?)Email* Current Phone NumberPreferably a cell phonePermanent Phone NumberCurrent Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Permanent Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your Academic InformationCurrent Class StandingFreshmanSophomoreJuniorSeniorGPA Major(s) Minor(s) Expected Graduation Date Preferred Research Faculty MembersList, in order, your three preferred research faculty mentors as described on the projects page.Mentor 1*Dr. David MecerreyesDr. Maria ForsythDr. Haritz SardonDr. Alejandro MüllerDr. Fernando RuipérezDr. Irune VillaluengaDr. Ana Beloqui & Dr. Marcelo CalderonMentor 2*Dr. David MecerreyesDr. Maria ForsythDr. Haritz SardonDr. Alejandro MüllerDr. Fernando RuipérezDr. Irune VillaluengaDr. Ana Beloqui & Dr. Marcelo CalderonMentor 3*Dr. David MecerreyesDr. Maria ForsythDr. Haritz SardonDr. Alejandro MüllerDr. Fernando RuipérezDr. Irune VillaluengaDr. Ana Beloqui & Dr. Marcelo CalderonPreferred Research ProjectList, in order, your three preferred research projects as described on the projects pageProject 1*Design of Innovative Active Polymers for Next-Generation BatteriesPolymer Coatings as Corrosion InhibitorsOrganocatalysts for Polymerization ReactionsCrystallinity and Phase Behavior in Complex PolymersComputational Screening of Polymer-bound Catalysts for N2 ReductionEffect of Hybrid Block on Properties of Solid Block Copolymer ElectrolytesMultifunctional Polymer-Biohybrids for Redox Enzymes in ElectrochemistryProject 2*Design of Innovative Active Polymers for Next-Generation BatteriesPolymer Coatings as Corrosion InhibitorsOrganocatalysts for Polymerization ReactionsCrystallinity and Phase Behavior in Complex PolymersComputational Screening of Polymer-bound Catalysts for N2 ReductionEffect of Hybrid Block on Properties of Solid Block Copolymer ElectrolytesMultifunctional Polymer-Biohybrids for Redox Enzymes in ElectrochemistryProject 3*Design of Innovative Active Polymers for Next-Generation BatteriesPolymer Coatings as Corrosion InhibitorsOrganocatalysts for Polymerization ReactionsCrystallinity and Phase Behavior in Complex PolymersComputational Screening of Polymer-bound Catalysts for N2 ReductionEffect of Hybrid Block on Properties of Solid Block Copolymer ElectrolytesMultifunctional Polymer-Biohybrids for Redox Enzymes in ElectrochemistryMore About YouPersonal StatementBriefly describe your background, experience, and interest in the program.Interest in the ProgramBriefly describe your interest in the program.Your GoalsBriefly describe your goals over the next five years.Career GoalsBriefly describe your career goals.ReferencesPlease provide the e-mail address for the requested number of references. References will only be contacted as part of the final selection process.Reference 1 Name* Reference 1 Email* TranscriptSelect a transcript file to upload*Accepted file types: pdf, doc, docx, Max. file size: 10 MB.CAPTCHA