Application Form for IMA Mathematical Modeling in Industry XII

       Application Form for IMA Mathematical Modeling in Industry XII

                          August 6 - 15, 2008

Please submit recommendation letters by Fax 612-626-7370 or by Email
to mm-applications@ima.umn.edu. Deadline for Applications: April 28, 2008.
Successful applicants will be notified by May 5, 2008.

        First Name:   Last Name: 

       Institution: 

        Department: 
    Address Line 1: 
    Address Line 2: 
    Address Line 3: 
              City: 
              

              State:  Zipcode: 
           Country: 

             Email: 

             Phone: 

            Status: graduate student     year 

                    undergrad student    year 

      Arrival date:   Departure date: 

              Gender: FemaleMaleDecline to Report
              Race: American Indian or Alaskan Native
                    Asian
                    Black or African American
                    Hispanic or Latino
                    Native Hawaiian or Other Pacific Islander
                    White
                    Unknown
                    Decline to Report Race/Ethnicity

        Citizenship
(for visa purposes): 

Brief Background:

What is your career goal?


What courses have you taken that may be relevant to the workshop participation?


In the space provided, please state why you are interested in participating,
what are your expectations.


Please rank the industrial problems topics for this workshop in order of your
preference, 1 being most preferable, 6 being least preferable.
1.



Two letters of recommendations are required

       Recommender 1: 

       Recommender 2:

The University of Minnesota is an equal opportunity educator and employer.

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