Application Form for IMA Mathematical Modeling in Industry XIII

       Application Form for IMA Mathematical Modeling in Industry XIII

                          August 5 - 14, 2009

Please submit recommendation letters by Fax 612-626-7370 or by Email
to mm-applications@ima.umn.edu. Deadline for Applications: April 24, 2009.
Successful applicants will be notified by May 3, 2009.

        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 provide your top 3 choices (in ranked order) of the industrial
projects for this workshop.




Two letters of recommendations are required, one must be from your advisor,
director of graduate studies, or department chair.

       #1 recommendation from: 

       #2 recommendation from:

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

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