APPLICATION FOR ADMISSION

MEM Program Pratt School of Engineering Duke University, Box 90300 Durham, NC 27708-0300 Phone: (919) 660-5455 Fax: (919) 660-5456 e-mail: memp@pratt.duke.edu
Note: This application form must be accompanied by a non-refundable fee of US $75.00 payable via credit card online or via mailed check or money order (not cash) payable to Master of Engineering Management Program. No application is processed without this fee.

1. 2.

Application for Fall ________

year

Spring ________
year

( ) Female ( ) Male __________________________________________________________________________________

(PRINT)
last or family name first middle

3. 4.

US Social Security Number __ __ __ - __ __ - __ __ __ __ If none, check here ( ) Address for correspondence concerning your application. (Valid until ___________)

date _____________________________________________________________________________________________________________________________ number and street/apartment city state or country zip code

electronic mail address __________________________________ fax _________________________________ 5. Permanent home address ___________________________________________________________________________________________
number and street/apartment city state or country zip code

6. 7. 8.

Current phone ____________________ Date of birth __ __ - __ __ - __ __

month day year

Permanent address phone ________________________ Place of birth _______________________________________

Country of citizenship ______________________ Status if not a US Citizen: ( ) F1 ( ) J1 ( ) Permanent Resident of the US ( ) other:__________________ Race/National Origin (US Citizens and Permanent Residents only) (Please choose the one response ( ) White (not Hispanic) that best describes the way you ( ) Hispanic identify yourself.) ( ) African American

9.

( ) Native American ( ) Asian or Pacific Islander ( ) Do not choose to indicate

Duke University offers equal opportunity to all applicants without regard to race, color, creed, sex, age, or national origins. The questions concerning such matters on this application are for statistical purposes only.

10.

The Graduate Record Examination is Required. Date taken/scheduled ________________

month year

GRE Score Percentile

Verbal

Quantitative

Analytical or Written

TOEFL (if native language is not English): Total Score ______date taken/scheduled ________________
month year

Please report GRE and TOEFL scores to the program by using the institution code 5156; we do not use a department code.

11. 12. 13.

Are you applying to other Graduate Degree Programs? Are you going to be a ( ) Full-time or

( )Yes

( )No

( ) Part-time Student?

Will you be enrolled in a concurrent degree program with the MEMP at Duke? ( )Yes ( )No If so, which program? ( ) MS ( ) PhD ( ) BS ( ) MBA ( ) JD How did you learn about us? ( ( ( ( ( ( )Search Engine, e.g. Google )Print Advertisement )Petersons Guide Paper )By word of Mouth )E-mail Solicitation )Letter ( ( ( ( ( ( )Poster with Cards )Online Advertisement )Petersons Guide Online )School Advisor )Site Visit: Location:________________________________ )Other: Explain:

14.

15.

List any institution where you earned (or will earn) a degree, studied for one year or more, or took classes that relate to your current application for graduate study. [An official transcript from each institution listed is required]
Dates attended (month & year) From To Degree or Diploma Grade Point Average Date Received or Expected (month/year)

Name of Institution and Location (List Undergraduate degree school first)

Major Field of Study

If you are still in school and are admitted into the program, you will receive a Provisional Letter of Admittance asking for your final transcript to be sent to us before you will be able to start the program. 16. Provide two letters of reference. These should include a reference familiar with your academic work and with your professional work, if applicable, and should be mailed directly to the Engineering Management Program Office . List below. Name Position Address

17. If you have graduated, give your present professional position. Then list in chronological order all full-time positions you have held for six months or longer. Please list the total number of years of professional work experience gained after receiving your bachelors degree. ______ Firm or Organization Job Title/Kind of Work Inclusive Dates

18.

Please indicate if you would like any of the above to be considered in lieu of the summer internship required in this program. Yes ( ) No ( ). If yes, please furnish more complete details below about your duties in this position. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Supervisor___________________________________________________________________________________
Name and Title Telephone

19. (a) Applicants who are U.S. citizens or Permanent Residents of the U.S. and who are applying for federal student loans must submit the Free Application for Federal Student Aid (FAFSA) form according to the instructions. The FAFSA form is available on line at: www.fafsa.ed.gov. Please mail your Student Aid Report (SAR) to Ms. Delia Partrick, Administrator, Financial Aid, 1 Towerview Drive, Box 90128, Durham, NC 27708-0128 (b) NonU.S. citizens: U.S. immigration law requires proof that sufficient funds are available to the student to cover expenses during all academic years of study before a visa can be granted. If offered admission, you will be sent a Request for Temporary Visa form that you must complete and return if you plan to enroll in this program. 20. If you authorize anyone other than yourself to receive information regarding the status of your application, please indicate name and relationship. ____________________________________________________________________________________ Release of Personal Information for Externally-Sponsored Master of Engineering Management Fellowships (Optional): I authorize the Duke University Master of Engineering Management Program to release personal information contained in this application to potential fellowship sponsors. _________________________________________ Signature 22. ______________________________________ Date

21.

Enclose a one-page Statement of Purpose indicating your objectives in undertaking graduate study in the Master of Engineering Management Program. Enclose a one- or two-page rsum.

23.

I hereby certify that information given by me in this Application for Admission is complete and correct to the best of my knowledge. I further authorize Duke University Master of Engineering Management Program to contact recommenders, institutions attended, or employers to obtain any information related to this application for graduate study.

Signature of Applicant ___________________________________________ Date ______________________

Revised 07/07