DPMI Plus Application The following form lets the DPMI Plus team know you are interested in the program. Section 1: Current Contact Information Student I.D. Number * Family Name (Surname) * First Name (Given Name) * Permanent Email Address * Phone Number * (XXX) XXX-XXXX Section 2: Emergency Contact InformationPlease list one contact that can be reached in case of an emergency. Full Name * Street Address * City, State, Zip Code, and Country * Email address * Phone number (include country/city codes) * Section 3: Student Information Degree Program * - Select -IPDMPAIEPOther (Please specify): Degree Program Other (Please specify): Current semester * - Select -1st2nd3rd4th When do you plan to do DPMI Plus? * External support Please list any country or external scholarship programs you/we would need to contact to participate in DPMI Plus, either for timing or funding purposes. Select all that apply. How did you first hear about DPMI Plus? * GSIPM Blog Posting on Zocalo MIIS website MIIS new student orientation DPMI/DPMI+ info session Facebook announcement Email announcement Faculty member Fellow student Career Services Other (Please specify): How did you first hear about DPMI Plus? Other (Please specify): Section 4: ResumeIf you have trouble uploading your documents, please email them to dpmi@miis.edu. Resume or CV Please upload your resume or CV. Files must be less than 4 MB.Allowed file types: gif jpg png txt rtf odf pdf doc docx ppt pptx xls xlsx xml. Section 5: Organizational informationPlease list the organization you plan to serve or 1-3 organizations you plan to contact regarding an internship for DPMI Plus. Note: We recommend that you contact the organization only AFTER your resume and cover letter have been edited by your career advisor. Confirmed organization (if applicable) If you a confirmed internship for DPMI Plus, please list the name of the organization and the supervisor's contact information. Branch/Division Point of contact (if known) Location Email address (if known) Additional organizations you plan to contactPlease list any additional organizations you plan to contact (optional). Second organization name Branch/Division Point of contact (if known) Location Email address (if known) Section 6: If no confirmed organization (Optional) Please let us know your preferences In what area(s)/region(s) are you interested in working? Would you prefer a headquarters or field placement? - None -HeadquartersField officeOther (Please specify): Would you prefer a headquarters or field placement? Other (Please specify): What size organization are you most interested in working with? Small (3-20 employees) Medium (20-100 employees) Large (100+ employees) Other (Please specify): What size organization are you most interested in working with? Other (Please specify): What are your career plans after completing the DPMI Practicum? Section 7: Form submissionBy entering my name and date below, I confirm that I understand and agree to the Middlebury Institute’s Student Code of Conduct: Full Name * Date * Date of application Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022202320242025 Leave this field blank
