APPLICATION FORM


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

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)

Birthplace City

Birthplace country


Name of parents (or guardian)

Name

Address Home

City

Zip code

Country

Phone number

Fax number

Business phone number

Email


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

Please indicate the term for which you wish to apply




Educational history-Secondary school

Name of school + phone and fax number Address Dates of attendance Title of diplomas and date conferred


Educational history-College/University

Name of school + phone and fax number Address Dates of attendance Title of diplomas and date conferred

Academic honors (briefly describe scholastic distinctions or honors you have earned in high school or college)


Extra-curricular activities
Please list your extra-curricular, community and family activities, hobbies, and work experience in the order of their interest to you. (For example, musical instruments played, sports played, etc.).


Work experience

Name of the company Address Dates of attendance Tasks (including position and function)


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.




Are you interested in the "internship program"?
Yes No
If yes describe what type of internship you would like to follow during your stay at M.I.M (which area of work, size of company, function: marketing, finance, advertising, foreign trade, internet business…).


LIVING IN NEW YORK

Where do you plan to live?
With relatives, family or friends
In a private apartment or room (helpful information provided by the MIM)

If you have already found a place to live, please give

Address

Phone number

Fax number

Contact name

Contact phone number




When do you plan to come to New York?

When do you plan to leave New York?




INTERNSHIP APPLICATION FORM


Which kind of internship do you plan to do (general)?


What do you expect to learn?


Have you already contacted any company for an internship in New York City?
Yes
No

If yes, please indicate:
Name

Address

Phone number

Fax number

Contact (+position)

Where would you like to do your internship?

Industry (please give three choices)


Department, Duties


Any specific company?



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