Mr Mrs Ms 
Last name

First and middle names

Maiden name

Address (where you can be reached in the next few weeks)

City and Country

Zip or Postal Code

Telephone number (including area code)

Fax number

Email address

Nationality

A permanent resident of

Native language

Other languages spoken (please precise fluent or medium)


Marital status
Single Married

Date of birth (month/day/year)

City of Birth

Country of Birth

How did you hear about M.I.M. ? (multiple answers possible)
Internet
Friend
Through your school
Alumni
Other

Please indicate the term for which you wish to apply

Educational history-School/College/University

Please submit an essay that will enable the Admissions Committee of M.I.M. to know you as an individual. The Committee is also interested to see how well you are able to express yourself in writing. We place great emphasis on each applicant’s essay.
Please write an essay underneath of approximately two hundred words addressing the following topics:
Topic 1: Describe parts of your experience, not measured by application forms, that you believe to be important as you begin college work.
Or
Topic 2: Describe the way you envision your life 20 years from now. What have you chosen to do and why? What are your satisfactions, regret and hopes?

Please submit a brief statement (200 words max) of intent indicating your educational and personal goals, and how you feel your studies at M.I.M. might be instrumental in fulfilling them.

APPLICANT'S AFFIDAVIT

I certify that the information I have given on this application is complete and correct to the best of my knowledge. I also understand that if I am accepted to M.I.M., any admission is subject to verification of all official records from the institutions I have attended, including notice of graduation, when appropriate, and is contingent upon satisfactory completion of all course work prior to entering M.I.M.

By submitting this form I fully understand that medical coverage is under my responsibility. During my enrollment with the M.I.M. program, I will provide myself with full medical coverage.

                                                                                    I agree

                                                                                    I disagree