Applicant Information
Please input your first name
Please input your last name
Please input your MIT ID number
Please input your date of birth
Please input your gender
Please input your citizenship
First Name:
Middle Initial:
Last Name:
Class
Major
Are you returning to MAP?
Current Address
Please input your mailing address
Please input your city
Please input your state
Please input your zip code
Please input your phone number
Please input your e-mail
Mailing Address:
City:
State:
Zip Code:
Phone Number:
MIT E-mail:
@mit.edu
Matching Info: Demographics
Demographic Information: Please note that all information will be held in confidence with MAP staff ONLY and is used solely for matching purposes.
Desired Course of Study
Are you interested in graduate school?
(check all that apply):
Master’s program (M.Eng, MPH, MS, etc.)
Professional program (MD, JD, MBA, DMD, etc.)
PhD program (PhD, JSD, etc.)
No or Not Sure
Are you interested in research?
Yes
No
If “Yes”, please specify area/topic:
Gender:
Male
Female
Choose not to respond
Race/Ethnicity
(check all that apply):
Black / African-American / Caribbean-American / African
American Indian/Alaskan Native
Asian
Hispanic / Latino
Native Hawaiian or Other Pacific Islander
White
Middle-Eastern
Choose not to respond
Other
Religion:
(check all that apply):
Hometown City:
Hometown State:
Hometown Country:
Language(s) Spoken:
Sports and Arts
Sports:
(check all that apply):
Arts:
(check all that apply):
Matching Preferences
The following categories will be used to help us make your match. Please rank ALL of these categories (1 – 6), 1 being the most important consideration for your match.
Academic Interests
Same Gender
Race / Ethnicity
Religious Affiliation
Cultural Characteristics (languages, hometown)
Hobbies
Please rate the level of relationship are you seeking, 1 being Academic/Professional, 10 being Personal/Social.
Is there anything else we should know about you that would help us make the best match?
What do you hope to gain by participating in MAP?
Signature
Please sign the application.
I hereby grant permission to the MIT Office of Minority Education to obtain any and all academic records including college transcripts, current grades and/or academic progress reports. I also give permission for the program staff members to request similar information from this and future institutions for follow-up purposes after my enrollment in the program has ended.
Additionally, by signing this application, I certify that all of the information in this application is true and correct to the best of my knowledge.
Click the checkbox to sign this application