Visiting Student Application

* Please upload the current PDF version of your resume:

Prefix:
* First (Given) Name:
* Last (Family) Name:
* Email Address:

Gender:
	(male, female, other/self-describe, decline to answer)
Ethnicity and Race Providing the information below is voluntary and will not be used in a discriminatory manner. These questions comply with the U.S. Department of Education's standards for ethnic and racial data collection.
Are you Hispanic or Latino?:
(Hispanic/Latino means a person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin regardless of race.)
Race (Please select one or more that apply.):	African American or Black: A person having origins in any of the black racial groups of Africa. Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America) and who maintain cultural identification through tribal affiliation or community attachment. Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White: A person having origins in any of the original peoples of Europe, Middle East, or North Africa.

Web Site:

* Current Institution:
Primary Undergraduate Institution:
Status:
Undergraduate G.P.A.:

Will you need assistance from TTIC in obtaining a visa to study in the US?
Visa Assistance:
If so, list your English proficiency method and score. If planning to take the AEPA, enter "planning to take AEPA".
English Proficiency:


Please upload any additional documentation to support your application as a single PDF file:


Please list two references. On submission of this form an email will be generated requesting each reference to submit a letter of recommendation on your behalf.
Reference One:
* First Name:
* Last Name:
* Position:
* Email:
Reference Two:
* First Name:
* Last Name:
* Position:
* Email:
* Please select the opportunity you would like to apply for (at most 4):	General Opportunity with Ali Vakilian General Opportunity with Avrim Blum General Opportunity with David McAllester General Opportunity with Greg Shakhnarovich General Opportunity with Jinbo Xu General Opportunity with Julia Chuzhoy General Opportunity with Karen Livescu General Opportunity with Kevin Gimpel General Opportunity with Madhur Tulsiani General Opportunity with Matthew Turk General Opportunity with Matthew Walter General Opportunity with Nati Srebro General Opportunity with Saeed Sharifi-Malvajerdi General Opportunity with Yury Makarychev

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