Take the Next Step HereIndustry PhD Interest Form

Preferred First Name*

First (Given Name)

Last Name (Family Name)*

Email Address*

Note this email address will be used as an unique identifier to your record. Please use this email in any future forms you are asked to complete as part of Northeastern's Industry PhD pathway.

Undergraduate Institution Name*

Undergraduate Degree*

When did you receive your Undergraduate Degree?*

Type mm/dd/yyyy instead of using the calendar tool. If you don't know the day, just choose the first day of the month.

LinkedIN Page URL

Please select the PhD Programs you are Interested in Pursuing*

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The following questions are to determine your eligibility for the Northeastern Industry PhD pathway

1) Are you employed?*

Industry PhD students are all employed and their employer enters into an Academic Partnership with Northeastern. If your employer is not a current academic partner, that is OK, we can work with you to establish the partnership.

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Current Job Title*

Current Employer*

If your current employer isn't in the dropdown list, that's OK. Just type it in and if you are eligible for the Industry PhD pathway we will work with you and your employer to establish an academic agreement.

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Number of Years at Current Employer*

Current Job Location*

Please let us know the country where you will be working during your PhD*

1a) Do you plan to be employed for the duration of your PhD?*

Knowing your intended length of employment will help us determine if the Industry PhD is the best pathway for your continued studies.

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2) Do you require Northeastern sponsor your Student Visa?*

NOTE: Individuals who are employed through the Optional Practical Training (OPT) benefit for F-1 students should answer, "Yes I will need Northeastern to sponsor my visa."

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3) Do you have a Master's degree?*

PhD students who enroll with a Masters degree in hand have fewer coursework requirements, which is conducive to the Industry PhD pathway,

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Graduate Institution Name*

Please select the graduate degrees you will have received at the time of enrollment.*

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Fields of Study*

When did you receive your Graduate Degree?*

Type mm/dd/yyyy instead of using the calendar tool. If you don't know the day, just choose the first day of the month.

I would like to receive information about educational opportunities and programs at Northeastern that may be of interest based on the information I have provided.*

I understand that I can opt out at any time and that Northeastern will handle my information in accordance with its applicable Privacy Policy.

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Thank you for your responses to our eligibility questions.

Thank you for your interest in the Industry PhD pathway. By submitting this form you acknowledge that all information provided is true. After submitting this form you will receive important information about the next steps appropriate for the information you have provided. An email will be sent to the address you supplied from Smartsheet automation@app.smartsheet.com. Please check your spam folder if you do not receive the email.

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