Your Application ID *

Your Complete Name, including all middle names *

Your Given Name (First Name) *

Your Surname (Family name or Last name) *

Street 1 *

Street 2

City *

State/Province *

Postal Code *

Country *

Daytime Phone *

Evening Phone

Fax

Email Address: *

Skype:

Gender: * MaleFemale

Marital Status: MarriedUnmarried

Birthday: *

City of Birth: *

Country of Birth: *

Country of Citizenship: *

If you are not a U.S. citizen, do you have permanent resident status? YesNo

If you are not a U.S. citizen or permanent resident, do you have a visa to be in the U.S.? * YesNo

Type of Visa ( * required if you have a visa):

Expiration Date of Visa ( * required if you have a visa):

Native Language: *

Other Fluent Languages:

Have you been instructed in the Transcendental Meditation technique? YesNo

Have you ever been involved in any techniques for self-development? YesNo

Name/Type of Program:

Teacher and/or Organization:

From:

To:

Do you use non-prescription drugs, such as hallucinogens, marijuana, amphetamines, barbiturates, narcotics, etc.? YesNo

Type of Drug:

Quantity/Frequency:

Used From:

To:

Type of Drug:

Quantity/Frequency:

Used From:

To:

Name: *

Relationship: *

Address: *

Phone: *

What goals do you have for yourself, including both personal and professionals goals? *

What is your understanding of why the Transcendental Meditation technique is part of the curriculum at MUM? (See www.mum.edu/tm.html and www.tm.org.) (Please write this in your own words. Do not copy/paste information from the website or any other document.) *

Signature: *

Date: *