A P P L I C AT I O N F O R F R E S H M A N A D M I S S I O N 1 Office of Admissions Massachusetts Institute of Technology Room 3-108 Last / Family name 77 Massachusetts Avenue Cambridge, MA 02139-4307 (617)

253-3400 Date of birth ( Month / Day / Year )

Part 1

First / Given name

Middle initial

Biographical information

Have you applied to MIT for freshman admission before? No Yes, year MIT has a two-part application process: This form is Part 1. You should return this form to the address above immediately. You must also include the non-refundable $75 application fee (U.S. funds only). Please attach to the front of this application a check made payable to MIT Office of Admissions. We cannot process your application without the Part 1 and fee. If you qualify for a fee waiver, attach the SAT Request for Waiver of College Application Fee form (or an official letter from your guidance counselor, principal or other school official) to this application. The second part of the application process includes the Essays, activities, and tests form; teacher evaluations; Secondary school report; and Self-reported course work form. All pieces should be postmarked no later than the following dates: Early Action November 1 Regular Action January 1
2 I intend to apply (check the appropriate box): Early Action (For U.S. citizens and Permanent Residents only) You must complete all required standardized tests on or before the November test date. 3

The Midyear Report form should be submitted online as soon as first term grades are available.
Regular Action You must complete all required standardized tests on or before the January test date.

Biographical Information
Applicants Last / Family name First / Given name Female Middle initial Male Suffix

Applicants Legal Name Applicants Preferred Name Place of birth

U.S. Social Security Number

Home (permanent) Address

Mailing Address
Street address

(if different from your home address)

Street address

City

State or province

Zip or postal code

City

State or province

Zip or postal code

Country

Telephone

Country

Telephone

Email

Valid from: _____/_____/_____ through _____/_____/_____

Citizenship Information
U.S. Citizen

(Choose one option below):

U.S. Permanent Resident (Green Card holder): Country of citizenship If you are a Permanent Resident, you must mail in a copy of your Green Card to the Office of Admissions. Alien Registration Numbers cannot be accepted in lieu of a Green Card. Non-U.S. Citizen/Non-U.S. Permanent Resident: Country of citizenship Visa Type (if applicable)
(F-1, J-1, etc.)

Ethnicity Information (optional)

In connection with its Afrmative Action Plan, the Massachusetts Institute of Technology guarantees equal opportunity in education to students of all racial and ethnic backgrounds. I consider myself to belong to the following ethnic group(s) (check all that apply): 1) Are you Hispanic or Latino? Yes, Hispanic or Latino (including Spain) No Which best describes your background? Central America Cuba Mexico Puerto Rico South America Spain Other 2) Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member. American Indian or Alaska Native (including all Black or African American (including Original Peoples of the Americas) Africa and Caribbean) Which best describes your background? Which best describes your background? Alaska Native Chippewa Choctaw African American Caribbean Cherokee Navajo Sioux African Other Other Are you Registered? Native Hawaiian or Older Pacific Islander (Original Peoples) No Yes, my Registration number is Which best describes your background? Asian (including Indian subcontinent and Philippines) Guam Hawaii Samoa Which best describes your background? Other Pacific Islands (excluding Philippines) China India Japan Korea Pakistan Philippines Vietnam White (including Middle Eastern) Other East Asian Which best describes your background? Other Indian Subcontinent Europe Middle East Other Other Southeast Asian

A P P L I C AT I O N

F O R

F R E S H M A N

A D M I S S I O N

Part 1
Last / Family name First / Given name Middle initial Date of birth ( Month / Day / Year )

Family Information
Mother living?
First / Given

Mother:

Yes

No
Middle initial

Father:

Father living?
First / Given

Yes

No
Middle initial

Mothers Last / Family name

Fathers Last / Family name

Mothers occupation Mothers employer High School graduate? Yes Name of university, if any? Degree No Year

Fathers occupation Fathers employer High School graduate? Name of university, if any? Degree Year Name of professional or graduate school, if any? Degree Widowed Father Other Separated
Date separated

Yes

No

Name of professional or graduate school, if any? Degree Parents marital status: Married Year Never Married Mother

Year Divorced
Date divorced

If divorced or separated, live with:

If your legal guardian is someone other than your parent, list name, address, relationship, and occupation.

If you have brothers and/or sisters, give their names and ages. If appropriate, list college, degree and year of graduation next to their names. (Attach additional sheets if necessary)

What language is primarily spoken at home? If any members of your family have attended MIT, check the boxes below, give name(s), class years, relationship to you, and degree.
mother father grandparents
# attended

If any members of your family are employed by MIT, give name(s), relationship to you, and position at MIT.

siblings
# attended

other

If any members of your family are faculty at MIT, give name(s), relationship to you, and position at MIT.

If any members serve as an Educational Counselor (MIT alumni interviewer), give name(s) and relationship to you.

Educational History

List the secondary schools (high schools) you have attended or are attending (if more than one, put current one rst).
Name City State or Province Zip or Postcal Code Date entered Date of graduation

College Board School Code (6 digits)

College Board School Code (6 digits)

Name

City

State or Province

Zip or Postcal Code

Date entered

Date of graduation

College Board School Code (6 digits)

Name

City

State or Province

Zip or Postcal Code

Date entered

Date of graduation

9 What eld of study appeals to you most right now?

If you feel the need to clarify your answer to any question on this form, please use the Optional section at the end of Part 2.
10 I have completed all the applicable spaces on this form and I afrm their accuracy. I understand that any misrepresentation of the facts on this form may be cause for refusal or cancellation of admission.

Signature

Date

Check here if you plan to apply for nancial aid. Note: For clerical use only. Financial need has no bearing on admissions decisions. Checking this box allows Student Financial Services to assist you in completing your nancial aid application. Have you attached a check for the application fee in US funds or a fee waiver request to the front of this application? Have you attached a copy of your Green Card (if applicable)? Have you contacted your interviewer (Educational Counselor) to arrange an interview (if applicable)?
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