ICP Application Form: Fall Semester 2023-2024
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Email *
COURSE SELECTION (PLEASE SELECT ONE OR MORE COURSES) *
Required
2.    PERSONAL DATA
Family name: *
First name: *
Date of birth: *
MM
/
DD
/
YYYY
Academic degree: *
Citizenship: *
Are you from the Global South (you can check the official list here: https://tinyurl.com/283z2hxa) *
Organization membership/affiliation (optional):
3.        PROFESSIONAL/ACADEMIC DATA
University/Institution: *
Faculty: *
Department: *
Areas of Specialization: *
Status (Employee/Student): *
Position: *
Please indicate the motivation for enrolling in the School of Materialist Research’s Integrated Credit Program (* if you are from the Global South this will also factor into the decision to award 50% discount) *
5.        Please write a short bio (Approximately 200 words): *
6.        Contact Information:
E-mail: *
Address: (optional):
Phone (optional):
Do you wish to pay on installment plan (only for multiple course packages) 
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Are you applying for credit certificate courses?
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Are you applying for Drop-Ins (Auditing or 4+)?
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