ALL applications and materials must be recieved by: Fall Term Applications Due By: Spring Term Applications Due By: December 1

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1 SPECIAL STUDENT INFORMATION SHEET Phone (617) SPECIAL STUDENT DEADLINES ALL applications and materials must be recieved by: Fall Term Applications Due By: May 1 Spring Term Applications Due By: December 1 UNDERGRADUATE SPECIAL STUDENT STATUS If you are enrolled at another university and wish to study subjects not offered at your home university, you may apply to MIT as a non-degree undergraduate Special Student. Special Student status is available to individuals who have successfully completed at least one year of full-time study, or the equivelent, at the university level. Secondary school students are not eligible. Special students enjoy most of the privileges of matriculating students but are not eligible for campus housing or financial aid from MIT. Admission as a Special Student is valid for only one term (students must reapply each term) and does not imply admission as a degree candidate at a later time. Although applicants are considered undergaduate special students, the adminstration and application process is held within the Office of the Dean for Graduate Education. If you hold a bachelor s degree or higher, and are interested in taking classes as a non-degree student at MIT, you must apply through MIT s Advanced Study Program. Please visit their website at or contact them at advancedstudy@mit.edu for more information. APPLICATION PROCEDURE A person seeking admission as a non-degree undergraduate Special Student must apply through. Complete applications for a given term must be filed before the deadlines given above, including a $75 application fee. All materials must be mailed to the provided address. Persons applying for the first time must submit an Application for Special Student Admission, one Special Student Evaluation (from a teacher, dean, professor, or current work supervisor), and a certified transcript from each college previously attended. Special Students may not register for thesis, research (UROP for undergraduates), IAP, or other subjects for degree candidates only. Regular students will be given preference for registration in subjects with limited enrollments. All applications will be reviewed by Special Studnet Admissions and the relevant department(s). Applicants wishing to audit courses are subject to the same regulations, including tuition, as those taking courses for credit. notifies all applicants of admissions decisions. If the applicant is admitted, further information about registration and tuoin payment options will be provided. Current course offerings are viewable online at QUALIFICATIONS A person who does not possess an undergraduate degree will be considered an Undergraduate Special Student. Undergraduate Special Students are limited to two terms. Special Student status is a guest status only and not a means to an undergraduate degree at MIT. Qualifications for admission as a Special Student are not appreciably different from those expected of a regular student. The department to which the student applies will evaluate an applicant s qualifications for the specific course(s) desired. Prior instructor approval does not ensure admission. If an individual is applying to take subjects in more than one department, approval of the Registration Officer in each department is required. Final approval is at the discretion of. All admitted Special Students must receive satisfactory grades in order to reapply for future terms. For former MIT students, any course grade you receive as a Special Student will contribute to your cumulative MIT grade-point average. Visiting Students cannot register without changing their status.

2 SPECIAL STUDENT INFORMATION SHEET MIT EMPLOYEES MIT employees may be eligible for reimbursement of one MIT course per term through the Tuition Assistance Plan. Employees must adhere to the same application procedures, deadlines, and qualifications as all Special Students. Once they are admitted as a Special Student, employees must submit additional information to the Benefits Office in order to obtain a tuition deferment prior to the start of class. If students successfully complete their course by earning a minimum final grade of C- or better for an undergraduate course or B- or better for a graduate course, and if they remain eligible to participate in the Tuition Assistance Plan through the last day of their course, their student account will be credited with the amount of the tuition (a prorated amount for part-time employees) by an internal transfer of funds. Please note that auditing a course is not permitted under the Tuition Assistance Plan. Further information is provided in the Employee Benefits section of the Human Resources website at A candidate for admission as a Special Student who is employed by MIT must obtain the approval of his/her supervisor. The supervisor must indicate approval by signing in Section 9 of the application form. Signature approval must be obtained prior to submitting the application. INTERNATIONAL STUDENTS A student who is neither a United States citizen nor a United States Permanent Resident is considered an International Student. In addition to the academic documentation required for admission as a Special Student, international applicants must submit a photocopy of their official TOEFL (Test of English as a Foreign Language) or IELTS (International English Language Testing System) score. The minimum required scores are 90 on the TOEFL internet-based test and 7 on the IELTS. Some departments may have higher score requirements; please visit the relevant department's website for further information regarding minimum score requirements. All transcripts must be certified and officially translated into English. After admission to MIT, the applicant must provide evidence of their ability to meet all financial obligations of study at MIT, including tuition and living expenses. Please note that living expenses for married students are substantially higher. The form 1-20 or DS 2019 will not be issued for subject registration of less than 36 units. Most subjects at MIT are either 9 or 12 units each. Full-time tuition will cover 36 units or more. An international student who holds a student visa at another university or any non-resident visa holder should contact the International Students Office for information on transfer or change of visa status procedures. International students are not permitted to cross-register at Harvard University. FEES Those applying for Special Student status for the first time pay a $75 application fee, which will cover two sequential terms. Otherwise, a new fee will be required for each term. For information about tuition and fees please visit the Office of the Registrar at: Special Students are charged a prorated fee for any course dropped after registration day and are charged in full for any course added. A Student Life fee is required of all Special Students who are not MIT employees, employee dependents, or student dependents. Special Students carrying 27 or more units, or Special Students on a J1 visa regardless of the number of units, are also required to have health insurance. Special Students with comparable insurance may submit a waiver to the Student Health Plan office for the Student Extended Insurance Plan via the on-line waiver system (see "Medical Care" section below). MEDICAL CARE Massachusetts state law requires Special Students carrying 27 or more units, or Special Students on a J1 visa regardless of the number of units, to have health insurance. Students paying tuition to MIT are automatically enrolled in the Student Extended Insurance Plan, which meets the state health insurance requirement. Students who have other insurance that meets Massachusetts requirements can ask to waive mandatory enrollment in the MIT Student Extended Insurance Plan. For further information visit the Student Health Plan website at or contact the Student Health Plan office at or stuplan@med.mit.edu. All Special Students must show evidence of required inoculations and submit a Medical Report Form to the MIT Medical Department. Special Students with a chronic medical condition are urged to identify their condition on the Medical Report Form. The Medical Report Form must be submitted to the MIT Medical Department prior to Registration Day. For further information or questions on the Medical Report Form, contact medrpt@med.mit.edu.

3 Phone (617) Last/Family/Surname First/Given name Middle initial of birth (Month/Day/Year) 2 I am applying for: o Fall Term 20 o Spring Term 20 This is the application to study at MIT as a non-matriculating, non-degree student. This form must be submitted each semester. This application plus supporting documents must be submitted by: 2I am applying for: o Full-Time Status o Less than Full-Time Status (e.g. Part-Time, Half-Time, etc.) Fall Term May 1 Spring Term December 1 ALL applications due by: 3 Have you ever applied to MIT before? o Yes o No If yes, select appropriate boxes and indicate term and year: o Undergraduate o Graduate o Special o Transfer Did you enroll? o Yes o No If you enrolled, have you ever withdrawn from MIT? o Yes o No 4 Biographical information Applicant s legal name Last/Family/Surname First/Given name Middle Suffix (Jr., III, etc.) Applicant s preferred first name o Female o Male of birth Place of birth Month/Day/Year City/State or province/country 5 Addresses Please notify us if your address changes. Home (permanent) address If your mailing address differs from your home address, mailing address is valid from: through beginning date ending date Mailing address (if different from your home address) Street address Street address City State or province ZIP or postal code ( ) Country Area or country code Telephone City State or province ZIP or postal code ( ) Country Area or country code Telephone address Special Student status is for one term only and is contingent on approval of the specified course(s) by both the relevant department(s) and the Office of Admissions. I understand that admission as a Special Student does not imply present or future admission to MIT as a degree candidate. I understand that prior instructor approval does not ensure admission. I understand that final approval is at the discretion of the Office of Admissions I understand that as a Special Student applicant, I may not attend classes until I have been notified by the Office of Admissions. I understand that any course changes after admission has been granted will require additional approval by the Office of Admissions. I understand that Special Students are charged a prorated fee for any course dropped after registration day and are charged in full for any course added. I have completed all applicable spaces on this application and I affirm their accuracy. I understand that any misrepresentation of facts on this application may be cause for refusal or cancellation of admission as a Special Student. Signature

4 6 Citizenship information Choose one option below. U.S. Citizen U.S. Permanent Resident (Green Card holder) Country of citizenship Attach a photocopy of your Green Card. Non-U.S. Citizen/Non-U.S. Permanent Resident Country of citizenship Visa Type (if applicable) (F-1, J-1, etc.) 7 Optional (U.S. citizens and permanent residents only) In connection with its Affirmative 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 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 Original Peoples of the Americas) Black or African American (including Africa and Caribbean) African American Caribbean Alaska Native Chippewa African Choctaw Cherokee Other Navajo Sioux Native Hawaiian or Other Pacific Islander (Original Peoples) Other Are you registered? Guam Hawaii No Yes, my registration number is Samoa Asian (including Indian subcontinent and Philippines) Other Pacific Islands (excluding Philippines) White (including Middle Eastern) China India Japan Korea Europe Middle East Pakistan Philippines Vietnam Other East Asian Other Indian Subcontinent Other Southeast Asian 8 Educational History List any technical institutes, junior colleges, four-year colleges or universities you have attended, or are currently attending (including MIT). Name entered Name entered City State departed City State departed ZIP/Postcode Country Degree(e.g.BA,BS,etc.) ZIP/Postcode Country Degree(e.g.BA,BS,etc.) Student Year Status (Sophomore, Junior, Senior OR 2nd, 3rd, 4th year etc.) Student Year Status (Sophomore, Junior, Senior OR 2nd, 3rd, 4th year etc.) 9 Employer Information Please give the name of your employer, if other than MIT. Company Supervisor City State Country If you are employed by MIT, please specify: o Staff o Non-Staff o Lincoln o Other Department Supervisor name, title, and MIT extension (please print) Supervisor signature of approval

5 10 Non-native English speakers Please indicate your TOEFL or IELTS score and date of test. Last/Family/Surname First/Given name Middle initial of birth ( Month / Day / Year ) Test score of test 11 Statement What is your objective in applying for admission as a Special Student? Please be specific. Please attach a separate sheet of paper. 12 Courses Please list the courses you would like to enroll in. MIT employees are eligible to receive Tuition Assistance for one course per term. Class listings may be found online at: ***IMPORTANT*** Please make sure to read the symbols help page at: Classes with the leaf symbol are availible in the Fall term. Classes with the flower symbol are availible in the Spring term. Classes with the slash symnol are not availible. If you choose classes that are not availible for the term you apply for your application will not be approved. For department use only. signature

6 CHECKLIST o Completed Application Form o Official Transcript(s) in English o Evaluation Form o $75 non-refundable application fee (U.S. dollars) Use a check or money order payable to MIT International Students o Photocopy of Permanent Resident or Green Card (if applicable) o TOEFL or IELTS score (photocopy of the official score report) Mail application packet to: The MIT Bulletin For detailed course listings and degree requirements consult The MIT Bulletin (Course and Degree Catalogue), which you can order through the MIT Press Bookstore by calling (617) They can also be ordered online at The cost is $5.00 plus shipping, and it is available for delivery to anywhere in the world. Course descriptions are also available on the Web: MIT s policy of nondiscrimination The Massachusetts Institute of Technology is committed to the principle of equal opportunity in education and employment. The Institute does not discriminate against individuals on the basis of race, color, sex, sexual orientation, religion, disability, age, veteran status, ancestry, or national or ethnic origin in the administration of its educational policies, admissions policies, employment policies, scholarship and loan programs, and other Institute-administered programs and activities, but may favor U.S. citizens or residents in admissions and financial aid.* The Vice President for Human Resources is designated as the Institute s Equal Opportunity Officer and Title IX Coordinator. Inquiries concerning the Institute s policies, compliance with applicable laws, statutes, and regulations (such as Title VI, Title IX, and Section 504), and complaints may be directed to Laura Avakian, Vice President for Human Resources, Room E19-239N, (617) or to Philip Lima, Coordinator of Staff Diversity Initiatives, Room E19-215, (617) Inquiries about the laws and about compliance may also be directed to the Assistant Secretary for Civil Rights, U.S. Department of Education. * The ROTC programs located on the MIT campus are operated under Department of Defense policies and regulations, and do not comply fully with MIT s policy of nondiscrimination with regard to sexual orientation. On the recommendation of the Faculty, MIT is working to develop a modified on-campus ROTC program open to all MIT students. MIT s use of information MIT is committed to protecting the individual privacy of applicants and students by restricting the use of all collected information as specified by Institute policies. In accordance with these policies, the information on this application may be used by MIT officials only for appropriate administrative and research purposes. Safety and security The MIT Annual Security and Fire Safety Report for 2012, prepared by the MIT Police Department, is a comprehensive publication required by the Department of Education, also known as the Jeanne Clery Act. This publication provides an overview of the MIT Police Department, it services, campus security policies, and crime and fire statistics, is available upon request from MIT Police Headquarters, at W89, 77 Massachusetts Ave., Cambridge, MA or online at This handbook is also available at HR and from the Admissions Office.

7 SPECIAL STUDENT EVALUATION FORM Phone (617) Under the Family Educational Rights and Privacy Act (Buckley Amendment), a student enrolled at MIT has access to his or her educational records. To the Applicant: Sign your name below only if you agree to voluntarily waive your right of access to review this recommendation. Applicant Signature Name of Applicant College Attending, or Last Attended To the Applicant: This form should be completed by a professor or by someone in a supervisory capacity under whom you are employed. To the Endorser: We shall be grateful if you will give us your evaluation of this applicant. Please use examples where relevant. Name Address Position Signature of evaluator Length of time acquainted with applicant Please return directly to,, MIT