Applicant's Contact Information

First Name:

Last Name:

Address:

Current Institution/
Organizational Affiliation:

Telephone:

Email:

Reference Information

[Please include name, email, and postal address for referees. Your application is complete with three references, if you feel more are necessary, please list the name(s) of additional referees in the box below.]

Reference 1:

Reference 2:

Reference 3:

Reference 4:

The Massachusetts Institute of Technology is committed to the principle of equal opportunity in education and employment. The Institute does not discriminate against individuals on the basis of race, color, sex, sexual orientation, religion, disability, age, veteran status, ancestry, or national or ethnic origin in the administration of its educational policies, admissions policies, employment policies, scholarship and loan programs, and other Institute administered programs and activities, but may favor US citizens or residents in admissions and financial aid. In addition, MIT has adopted plans calling for affirmative action in employment on behalf of women, members of designated minority groups, disabled persons, and qualified disabled veterans and veterans of the Vietnam era. Copies of the Summary Statement of the MIT Affirmative Action plan are available upon request in the Human Resources Office.*

The following information is requested on a voluntary basis to assist only in the administration and implementation of MIT's Equal Opportunity/Affirmative Action Program. Refusal to provide this information will not subject an applicant or employee to any adverse treatment. All information provided will be kept confidential unless it is required by government officials investigating compliance.

Gender: Male Female N/A

Ethnic Origin (* see below for definitions):
[Hold 'CTRL' while clicking to select multiple responses] American Indian/Alaskan Asian/Pacific Islands Black Hispanic/Mexican Hispanic/Puerto Rico Other Hispanic White Other n/a

Notes:

*DEFINITIONS:

American Indian/Alaskan: Persons with origins in any of the original peoples of North America who maintain cultural identification through tribal affiliations or have community recognition as American Indians or Alaskan natives.

Asians or Pacific Islanders: Persons with origins in any of the orignal peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes for example, China, Japan, Korea, the Philippine Republic, and Samoa; and on the Indian Subcontinent, includes India, Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan.

Blacks (not of hispanic origin): Persons having origins in any of the Black racial groups of Africa.

Hispanics: Persons of Mexican, Puerto Rican, Cuban, Central or South American, or Other Spanish culture or origin, regardless of race. This does not include persons of Portuguese descent or persons from Central or South America who are not of Spanish origin or culture.

* The Vice President for Human Resources is designated as the Institute's Equal Opportunity Officer and Title IX Coordinator. Inquiries concerning the Institute's policies, compliance with applicable laws, statutes, and regulations (such as Title VI, Title IX, and Section 504), and complaints may be directed to the Vice President for Human Resources, Room E19-291, 617-253-6512 or to Regina A. Caines, Director of Affirmative Action, Equal Opportunity and Diversity Programs, Room E19-226, 617-258-8718. Inquiries about the laws and about compliance may also be directed to the Assistant Secretary for Civil Rights, US Department of Education.