CCUS-STRP Application Form

CCUS-STRP Application Form

Southwest CCUS Training and Research Partnership (CCUS-STRP)
The Southwest CCUS Training and Research Partnership (CCUS-STRP) is a research and training program focused on Carbon Capture, Utilization, and Storage (CCUS). This application form is for consideration into the CCUS-STRP program and is not an application for university admission.

We anticipate accepting approximately 30 undergraduate students into the program per year. Accepted trainees will be provided stipends, mentorship, and research opportunities. Please complete all required sections to submit this form.
Please complete the required fields to apply for this opportunity. Questions marked with an asterisk (*) are required.
Biographic Information
Applicant's Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Date Today

MonthDayYear
Date
Age
Gender*

MaleFemale
Nationality / Citizenship*
Race/Ethnicity (Optional)

Hispanic or LatinoAmerican Indian or Native AlaskanAsianMiddle EasternBlack or African AmericanHawaiian/Pacific IslanderWhite/CaucasianOther
Are you a permanent resident of the State?*

YesNo
Are you authorized to work in the U.S.?*

YesNo
Education
Grade Level Completed*
Name of School Last Attended*
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
GPA*
Contact In Case of Emergency
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supplemental Materials
Transcripts*

Cancelof
Resume*

Cancelof
Acknowledgment
I hereby declare that the information I have provided above is true and correct to the best of my knowledge. I understand that any misleading or false information I provide that was substantial to the consideration of my application shall cause the termination of my participation in the program. I understand that this is not an application for employment and neither sets as a pre-qualification for future any employment.
Signature of Applicant*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
Should be Empty:

CCUS-STRP Application Form

Biographic Information

Education

Contact In Case of Emergency

Supplemental Materials

Acknowledgment