Part 1

Date of birth ( Month / Day / Year )

F R E S H M A N A D M I S S I O N A P P L I C A T I O N F O R
Female Male
Home (permanent) Address
Street address
State or province City Zip or postal code
Country Telephone
Mailing Address (if different from your home address)
Street address
State or province City Zip or postal code
Telephone Country

beginning date ending date

Valid from: _____/_____/_____ through _____/_____/_____
Ethnicity Information (optional)
Asian:
1) Are you Hispanic or Latino?
No Yes, Hispanic or Latino:
Citizenship Information
U.S. Citizen
U.S. Permanent Resident (Green Card holder): Country of citizenship
Please mail a photocopy of your Green Card to the MIT Office of Admissions.
Non-U.S. Citizen/Non-U.S. Permanent Resident: Country of citizenship
Visa Type (if applicable)
(F-1, J-1, etc.)
2) Please check one or more of the following groups in which you consider yourself to be a member.
Parents Marital Status: Never Married Widowed Separated Divorced Married
Mother Father If divorced or separated, live with: Other
Date Separated Date Divorced
Legal Guardian:
Siblings:
Early Action Regular Action
Place of Birth:
City / State or Province / Country
Applicants Preferred Name:
Email
First / Given name Middle initial Suffix Applicants Last / Family name
Applicants Legal Name:
American Indian or Alaska Native:
Are you Registered? No Yes, my Registration number is
Black or African American:
Native Hawaiian or Other Pacific Islander:
White:
Family Information
Yes High School Graduate? No
Name of university, if any?
Parent 1/Mother Living? Yes : No
Middle Initial Last / Family Name First / Given Name
Occupation
Employer
Degree Year
Name of professional or graduate school, if any?
Degree Year
Highest Level of Education:
Middle Initial Last / Family Name First / Given Name
Occupation
Employer
Yes High School Graduate? No
Name of university, if any?
Degree Year
Name of professional or graduate school, if any?
Degree Year
Highest Level of Education:
Parent 2/Father Living? Yes : No
Country of Birth: Country of Birth:
Housewife
+919562613599
K.
Falalu
Musthafa
Bachelor Of Commerce
Kerala
High School
Tirur, Kerala
1988
India
Associate's Degree
Business
High School
INDIA
04/08/2000
676109
INDIA
High School Diploma
P.S.M.O College Thirurangadi
1984
Rahman
Ummusalma
1993
C.K.
Self EMployed
Changampalli Kodieniyil
G.H.S.S. School Niramaruthur
meet.falalu@gmail.com
G.H.S.S School Niramaruthur
*************************DRAFT**************************
*************************DRAFT**************************
Self Employed
India
Educational History
Name City State or Province Date entered College Board School Code (6 digits) Date of graduation
Name City State or Province Date entered College Board School Code (6 digits) Date of graduation

What eld of study appeals to you most right now?
MIT Afliation
Applicants Name ( Last / Family Name, First / Given Name, Middle Initial ) Date of Birth ( Month / Day / Year )
Electronic Signature:
Signature Date
Part 1 continued
A D M I S S I O N A P P L I C A T I O N F O R F R E S H M A N
What language is primarily spoken at home?
Have you applied to MIT for freshman admission before No ? Yes, year
C6F4D9-6^
Attended MIT:
Employed by MIT:
Educational Counselor:
Faculty at MIT:
Zip or Postal Code
Zip or Postal Code
College Board School Code (6 digits) Name City State or Province Zip or Postal Code Date entered Date of graduation
Please tell us moie about youi cultuial backgiound and identity in the space below (100 woid limit). If you need moie than 100 woids, please use the
Optional section on Pait 2.
Tirur, Kerala
Riyadh
MES Central School, Tirur 10/2012
08/2006
Falalu
Falalu September 12, 2013
9
04/08/2000
S A 9 9
Computer Science & Engineering
U
Yara International School
I am an Indian and my home state is Kerala.
Rahman
Rahman
676101
04/2012 SAUDI ARABIA
01/2014 INDIA 9
Malayalam
9
*************************DRAFT**************************
D N I 9