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A P P L I C A T I O N F O R F R E S H M A N A D M I S S I O N Female Male Early Action Regular Action

Part 1
Applicants Legal Name:

11/28/1994
Date of birth ( Month / Day / Year )

Bento
Applicants Last / Family name

Eduardo
First / Given name Place of Birth:

S
Middle initial Suffix

Applicants Preferred Name:

Macau, China
City / State or Province / Country (if different from your home address)

Home (permanent) Address Praceta dos Narcisos, 5

Street address

Mailing Address

Herdade da Aroeira
Street address

Charneca da Caparica
City State or province

2820-543
Zip or postal code City State or province Zip or postal code

PORTUGAL
Country

+351962714473
Telephone Country Telephone

albersoa@netvisao.pt
Email

Valid from: _____/_____/_____ through _____/_____/_____

beginning date ending date

Citizenship Information

U.S. Citizen U.S. Permanent Resident (Green Card holder): Country of citizenship Please mail a photocopy of your Green Card to the MIT Office of Admissions. Non-U.S. Citizen/Non-U.S. Permanent Resident: Country of citizenship Visa Type (if applicable)
(F-1, J-1, etc.)

PORTUGAL

Ethnicity Information (optional)

1) Are you Hispanic or Latino? No Yes, Hispanic or Latino: 2) Please check one or more of the following groups in which you consider yourself to be a member. American Indian or Alaska Native: Are you Registered? No Yes, my Registration number is Black or African American:

Native Hawaiian or Other Pacific Islander: Asian:

White:

Family Information
Parent 1/Mother: Living? Yes No Parent 2/Father: Living? Yes No

Soares
Last / Family Name

Luza
First / Given Name

S
Middle Initial

Bento
Last / Family Name

Raimundo
First / Given Name

V
Middle Initial

Country of Birth: Occupation Employer

Macau

Country of Birth: Occupation

Macau

Civil Servant Macau's Government

Employer Yes No Year High School Graduate? Name of university, if any? Yes No High School Graduate? Name of university, if any? Degree Name of professional or graduate school, if any? Degree Highest Level of Education: Parents Marital Status: Married Year

University of Saint Joseph Business Administration Degree Year 1999 University of Saint Joseph Degree Government Study Year 2012

Name of professional or graduate school, if any?

High School Diploma

Never Married Mother Father

Highest Level of Education: Widowed Other Separated

If divorced or separated, live with: Legal Guardian:

Date Separated

Some graduate work Divorced 02/2004

Date Divorced

Siblings:

Elisa Bento (28)

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A P P L I C A T I O N F O R F R E S H M A N A D M I S S I O N

Part 1 continued
Bento Eduardo S

11/28/1994
Date of Birth ( Month / Day / Year )

Applicants Name ( Last / Family Name, First / Given Name, Middle Initial )

What language is primarily spoken at home?

Portuguese

MIT Affiliation
Attended MIT:

Employed by MIT:

Faculty at MIT:

Educational Counselor:

Educational History

Colgio Guadalupe
Name

Seixal
City

PORTUGAL
State or Province

2855-62009/2009 07/2012
Date entered Date of graduation

College Board School Code (6 digits)

Zip or Postal Code

College Board School Code (6 digits)

Name

City

State or Province

Zip or Postal Code

Date entered

Date of graduation

College Board School Code (6 digits)

Name

City

State or Province

Zip or Postal Code

Date entered

Date of graduation

What field of study appeals to you most right now? Pre-medicine

Have you applied to MIT for freshman admission before?

No

Yes, year

Electronic Signature:

Eduardo
Signature

Bento

Dec 29, 2011

Date

C6F4D9-6^