Application for Admission
MIT Professional Education Career Reengineering Program 2009 - 2010

ALL REQUIRED INFORMATION must be completed.
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complete the missing information, then submit again.

(*) indicates required information.

Application Reference Information
*Full Name:
*Email Address:
*Confirm Email Address:

Personal Information
Prefix:
 Dr.Mr.Ms.Mrs.
*Last (Family) Name:
*First Name:
Middle Initial:
*Date of Birth:
 Month Day Year
*Birthplace:
 City, State
Country
*Citizenship:
*Permanent Resident of:

Contact Information
*Address to Reply:
 BusinessHome (Please Check One)
Home Address
*Home Address:
*Telephone (voice):
Telephone (fax):
Email address:
Business Address (if applicable)
Business Name:
Business Address:
Your Position:
Telephone (voice):
Telephone (fax):
Email address:

Education
University Study 1
*University 1:
*Dates attended:
*Major Field:
*Degree Obtained:
University Study 2 (if applicable)
University 2:
Dates attended:
Major Field:
Degree Obtained:
University Study 3 (if applicable)
University 3:
Dates attended:
Major Field:
Degree Obtained:
Describe or list other educational programs and courses in which you have participated:

Additional items must be included with your application
  • Two letters of recommendation from individuals familiar with your professional or educational strengths.
  • College and postgraduate transcripts or records
  • A resume or career summary
  • A statement of the applicant’s educational and professional objectives (1-2 pages)
  • Participants are also required to attend an info session or schedule a 30 - 60 minute consultation session with the program director.

    Below give their names and titles:

    a. Your supervisor, previous supervisor, college teacher or colleague

    b. Second recommender

Financial

    Tuition must be paid before the start of the term.

    Tuition     for 2009-2010: $10,750* + $272 Student Life fee which will cover both the Fall and Spring semesters ($136 / semester x 2 semesters) .

    *All students who elect to stay at MIT to do research in the spring will be invoiced in December for an additional $5,335. This fee covers spring registration of up to 9 units.

*Source of Support:

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

How did you hear about this program?:

Please submit this application electronically by pressing the
"Submit Query " 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: Career Reengineering Program
    77 Massachusetts Avenue, Building 35-433
    Cambridge, MA 02139-4307

    If you have any questions, please call 617-258-6438; fax: 617-258-8831, or e-mail: (career-reengineering@mit.edu).