(Please check)

_____ System Dynamics Foundation:  Managing Complexity

_____ System Dynamics for Insight

Term(s):

__ Spring 2000 __ Summer 2000 __ Fall 2000 __ Spring 2001

Delivery Method: _____video streaming*

Name /Business & Home Addresses: __Dr. __Mr. __Ms.__ Mrs.

Family Name:__________________First____________________MI:________

Date of Birth:_____Month ____ Day ____Year Citizenship:________________

Business Name:

_______________________________________________________________

Business Address:

_______________________________________________________________

_______________________________________________________________

Your Position:

_______________________________________________________________

Telephone Number: _____________ Fax: ______________ E-Mail____________

Home Address:

_______________________________________________________________

_______________________________________________________________
 

Telephone Number: ________________________________

Permanent Resident of:_________________________

Address to Reply: (Please Check One): Business ___ Home ___

Financial Information

If your tuition will be paid by an organization or by another person, please attach a letter from the person or organization confirming willingness to provide appropriate financial support.

Name and address of person to be invoiced for your tuition if different from your own.

Name: __________________________________________________________

Address:________________________________________________________

English fluency for applicants for whom English is a second language:

TOEFL_________ TOEIC___________ Other___________

University Studies: ________________________Dates Attended:____________

Major Field: ______________________________Degree Obtained:___________

List other education programs and courses in which you have participated:

_______________________________________________________________

_______________________________________________________________

Have you previously been admitted to take course(s) at MIT's Advanced Study Program in System Dynamics?     yes ______  no ______
 
 

If "yes" which course(s)	Term(dates)
______ System Dynamics Foundation: Managing Complexity	____________
______ System Dynamics for Insight	____________
______ Topics in System Dynamics	____________

If "no" please complete the following education.

Mathematics

Please indicate level of mathematical comfort. Note the single pre-requisite for this course is the potential to excel in system dynamics. We anticipate that all participants will have facility with high school algebra. Understanding your mathematical preparation beyond algebra will help us provide appropriate material and support. Please circle which applies to you.

Algebra (required) 
 

	__________________________________
	1	2	3	4	5
	(none)				(a lot)

Calculus 
 

	__________________________________
	1	2	3	4	5
	(none)				(a lot)

Differential equations 
 

	__________________________________
	1	2	3	4	5
	(none)				(a lot)

Control Theory 
 

	__________________________________
	1	2	3	4	5
	(none)				(a lot)

Other

Additional items to be included with your application:

*A brief summary of your professional career.
*A brief summary of any prior work related to system dynamics.
*A statement indicating your immediate and ultimate objective in the Program.

*Two references we can contact in support of your application - i.e. your current or previous supervisor, teacher, or colleague. Below give their names, titles, addresses, telephone numbers and /or e-mail addresses.

a.______________________________________________________________

_______________________________________________________________

b.______________________________________________________________

_______________________________________________________________

Signature: _______________________________________________________

Date: ___________________________________________________________

How did you hear about this course?___________________________________

Please mail or fax this application and all supporting materials to:

Ms. Diana V. Garcia-Martinez, Director, Advanced Study Program
Center for Advanced Educational Services, Bldg. 9, Room 335
Massachusetts Institute of Technology
77 Massachusetts Avenue
Cambridge, MA 02139-4307, U.S.A.
Fax: 617-258-8831

If you have any questions, please call 617-253-6128, send a fax, or
e-mail message (caes-asp@mit.edu).

*Videotypes can be purchased at an additional cost (plus shipping and handling) if you cannot access video streaming.