Application for Admission
FOR ON-CAMPUS FELLOWS

(*) indicates required information.

ALL REQUIRED INFORMATION must be completed. If you get an error message, use the 'back' button on your browser, complete the missing information, then submit again.

Application Reference Information
*Full Name:
*Email Address:
 (required)

Term(s)
    Please check year for each term you expect to attend:

    Fall 2009 Spring 2010

    Fall 2010 Spring 2011

    Please also check: Full time Half time Quarter time

Personal Information
Prefix:
 Dr.Mr.Ms.Mrs.
*Family Name (only):
*First Name (only):
Middle Initial:
*Date of Birth:
 MonthDayYear
*Birthplace:
 City
Country
*Citizenship:
*Permanent Resident of:
*Address to Reply:
 BusinessHome (Please Check One)
Family Information
(REQUIRED for international students whose spouse & children will also come to the US)
Married?
 YesNo
Will your spouse be with you?
 YesNo
Spouse's full name:
Will your children be with you?
 YesNo
Names and ages:

Business Address
*Business Name:
*Business Address:
*City, State, Country, Zip Code:
*Your Position:
*Telephone (voice):
*Telephone (fax):
*Email address:

Home Address
*Home Address:
*City, State, Country, Zip Code:
*Telephone (voice):
Telephone (fax):
Email address:

Have you ever applied to MIT Before?
If Yes, what year & program:

Education
University Study 1
*University 1:
*Dates attended:
*Major Field:
*Degree Obtained:
University Study 2
University 2:
Dates attended:
Major Field:
Degree Obtained:
Describe or list other education programs and courses in which you have participated:

Additional items to be included with your application
• Non-refundable application fee of $75.00
• Resume or CV
• Statement of applicant’s educational objective
• Preliminary list of courses ( see: http://web.mit.edu/catalogue/)
• Official college(s) transcript(s) – originals
• One letter of nomination confirming financial support from company**
• Two current letters of recommendation – supervisor, college professor, or colleague
• Official TOEFL or other valid exam score if English is a second language
** If self-supporting, you must provide a bank letter/statement indicating funds available.

Below give their names and titles:

a. Your supervisor

b. Previous supervisor, college teacher or colleague

Nomination and Financial

    Tuition* must be paid before or on Registration Day.

    Per-semester fees for 2009-2010 are: $21,375 for full time; $14,750 for half-time, and $7,020 for quarter-time study. *Tuition and fees for the 2010 - 2011 academic year will be set in April, 2010.

    A letter of nomination written by a principal executive of your organization, confirming approval of your candidacy and willingness to provide the appropriate financial support is required.

    Please give the name, title and address of this nominator:

*Nominator Name:
*Address:
*Source of Support:

    Person to be invoiced for your tuition if different from nominator:
Name:
Address:

For visa purposes, we need the following information for applicants who are not U.S. citizens or permanent residents of the United States.
    *Amount of U.S. dollars you will have for each term for tuition & living expenses:

    English fluency for applicants for who English is a second language:

    If English is your second language please indicate your TOEFL score below:

    Paper Test Computer Test Internet Test

    (other test) ____________________________

    YOUR SUBMISSION OF THIS APPLICATION INDICATES THAT ALL THE INFORMATION IS COMPLETE, FACTUALLY CORRECT, AND HONESTLY PREPARED.

    Signature: __________________________________

    Date:_____________________

    How did you hear about this Program?

    Please be patient. Processing may take up to one minute.

Please submit this application electronically by pressing the "submit" button above. If you prefer, you may print and mail or fax the completed application to the following address below. In either case, you must send all supporting materials to the address below.


    MIT Professional Education
    Attn: Advanced Study Program
    77 Massachusetts Avenue, Building 35-433
    Cambridge, MA 02139-4307
    U.S.A.

    If you have any questions, please call 617-253-6128; fax: 617-258-8831, or e-mail: (advancedstudy@mit.edu).