Complete this form and send it using the "Submit" button below along with: (1) a 1-page personal Statement of Interest; and (2) an unofficial transcript.

E-mail item (1) and mail item (2) to: FACES - Undergraduate Research, c/o Dr. Reginald DesRoches, School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0355.

Name: 

Current Address: 

Current Telephone: 

Permanent Address: 

Permanent Telephone:   e-mail address: 

University / Department:       Major:      

Major GPA:        Overall GPA: 

Expected Graduation Date: 

Honors and Awards:

Ethnicity:

U.S. Citizen?

Permanent Resident? Yes No

Areas of interests within Major (i.e., ECE: microelectronics, CE: construction management)

Have you identified a faculty research advisor NoYes

If yes,  Faculty Name      Faculty E-mail