Master of Science in Instructional

Technology and Distance Education

Admission Application

Nova Southeastern University

Enrollment Processing Services (EPS)
ATTN: Fischler School of Education and Human Services
3301 College Avenue
P.O. Box 299000
Ft. Lauderdale, FL 33329-9905

Enrollment Processing Services (EPS)

ATTN: Fischler School of Education and Human Services
3301 College Avenue
P.O. Box 299000
Ft. Lauderdale, FL 33329-9905

Master of Science in Instructional

Technology and Distance Education
Admission Application

Thank you for applying to Nova Southeastern Universitys (NSU) Fischler School of Education and Human
Services (FSEHS). Please read the pages that follow carefully and complete the application in its entirety.
Submit application with a $50 nonrefundable application fee made payable to Nova Southeastern University
(NSU).
Application Instructions
The admissions packet should be addressed to:
Nova Southeastern University
Enrollment Processing Services
Attn: Fischler School of Education and Human Services
3301 College Avenue
P.O. Box 299000
Fort Lauderdale, Florida 33329-9905
Include with your application or send separately the following documents:
Official transcripts are required from the applicant for ALL previously attended institutions for FULL
admittance.
Applicants must hold a bachelors degree from a regionally accredited institution accredited institution
with Evidence of a cumulative GPA of a 2.5 or higher
o Applicants who do not meet the minimum CGPA requirement may enroll in a maximum of six (6) credit
hours and must earn a grade of B or higher in each course during the first term of enrollment for
conditional admission. Students who do not earn a grade of B or higher in each course maybe subject
to dismissal from the program.
o All foreign transcripts should be submitted with their official evaluation.
o Evaluation Information: http://www.naces.org/members.htm
o Foreign Students can also apply directly to West Education Services (WES) through the Office of
International Students by accessing the following URL: http://www.wes.org/nova.asp
Two Letters of Recommendation
o Recommendations must be provided by two different individuals
o Letters should state the applicants ability to succeed in a Masters Program
o Students have the option to submit two Recommendations Forms instead of two Recommendation
Letters. Recommendation Forms are attached to this Admissions Application packet.
Resume
MAT or GRE Test Scores (No minimum score required). The test must have been taken within the past five
years.
o Miller Analogies Test (MAT) (800) 622-3231, http://www.milleranalogies.com.
o Graduate Record Examination (GRE) (609) 771-7670, http://www.gre.org.
Page 2 of 10

For Non-Native English Speakers

Applicants who have indicated a language other than English as their primary language on their application form
will need to demonstrate English Language proficiency. This can only be done by submitting any one of the
following:
TOEFL score: 79
IELTS score: 6.0
SAT Verbal score: 480
GMAT score: 450
GRE score (Verbal & Quantitative): 1000

Academia 2 certificate from NSUs Language

Institute
High School diploma or GED issued in the U.S.
College Level Freshman English course passed with a
grade of C or better

For International Applicants

Applicants taking classes in certain FSEHS international clusters may be exempt from submitting MAT, GRE, and
TOEFL scores. Please contact the Fischler School Office of Student Services at (800) 986-3223, ext. 21559 regarding
requirements for your international cluster.
Alternative Admission Requirements
If you have earned a degree at a school that is not accredited by one of the regionally or internationally accrediting
associations/universities, you must submit the following information and documentation to petition for admission
into a Fischler School of Education and Human Services program at NSU.
Alternative One
Submit an admission application packet and include a $50 non-refundable application fee payment payable to NSU.
1. Send an official, course-by-course evaluation, with cumulative GPA, by one of the member organizations
approved by the National Association of Credential Evaluation Services (NACES) available at www.naces.org.
If the evaluation is not favorable, (i.e., does not indicate equivalency to a bachelors degree) applicants
must complete the Career Portfolio. The portfolio must demonstrate academic and pedagogical growth
appropriate for consideration into the applicants academic goal. The Career Portfolio Guide is available at
www.schoolofed.nova.edu/sso.
Send the portfolio and a $350 non-refundable portfolio evaluation fee made payable to NSU to the following
address:
Nova Southeastern University
Fischler School of Education and Human Services
Office of Student ServicesAdmissions Department
1750 NE 167th Street
North Miami Beach, FL 33162-3017
Alternative Two
1. Submit an admission application packet and include a $50 non-refundable application fee payment payable to
NSU.
2. Send evidence of an official license from one of the approved organizations below:
The National Board of License for Teachers and Principals (NBL)
Continuing Teachers License from Merkos Linyonei Chinuch International Board of License (MERKOS)
3. Submit the Career Portfolio. The portfolio must demonstrate academic and pedagogical growth appropriate for
consideration into the applicants academic goal. The Career Portfolio Guide is available at
www.schoolofed.nova.edu/sso.
Send the portfolio and a $350 non-refundable portfolio evaluation fee made payable to NSU to the address above.
Alternative Three
Page 3 of 10

1. Submit an admission application and include a $50 non-refundable application fee payment payable to NSU to
the address above.
2. Send an official transcript from one of the following institutions:
Binah Institute
The University of Guelph
Brock University
The University of Guyana
College of the Bahamas
The University of Ontario
Dalhousie University
The University of Ottawa
GC Foster College of Physical Education
The University of Technology
Institute of Management and Production
The University of Toronto
Jamaican Theological Seminary
The University of Victoria
McMaster University
The University of the West Indies (all campuses)
Northern Caribbean University
The University of Windsor
The University of Alberta
York University
The University of British Columbia
Note: The institutions listed above are subject to change without prior notification.

Page 4 of 10

Enrollment Processing Services (EPS)

Attn: Fischler School of Education and Human Services
3301 College Ave Design and Diversity Education
P.O. Box 299000 Admission Application
Fort Lauderdale, Florida 33329-9905

Master of Science in Instructional

Technology and Distance Education
Admissions Application

To complete admission process, please submit a nonrefundable $50.00 application fee and include your Social Security number on the
check or call 800-541-6682, ext. 25200, with your credit card information. Also, please note, you will be charged a $50.00 nonrefundable
application fee for each application submitted to our institution.
Circle expected start term:

Fall

Winter

Summer

20

How did you learn about NSU?

___________________________________________________________________________ Mark all that apply.
Friend/Colleague/Relative
Middle
First
Legal Name: Last
NSU Employee
___________________________________________________________________________
Maiden
Social Security Number _______________________________________________________
Do you have educational materials under another name, Social Security number, or ID?
No
If yes, then please indicate
Yes
__________________

NSU Student or Graduate

Direct Mail
TV or Radio Commercial
SREB Electronic Campus
eArmyU

Preferred Mailing Address:

Web Site (specify)

Newspaper (specify)

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________
Number and Street
City
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________
County
State
Country
ZIP Code
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________
Telephone
Cellular/Pager

Information Meeting (where)

Conference (specify)
Magazine (specify)
Other (specify)(e.g., adviser)
_______________________

Permanent/Legal Address:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________
Number and Street
City
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________
County
State
Country
ZIP Code
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________
Telephone
Cellular/Pager

FOR NSU USE ONLY

Business Address:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________
Name of Company
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________
Number and Street
City
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________
County
State
Country
ZIP Code
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________
Telephone
Cellular/Pager

Application Status at Time of Application:

Is this your first time applying to NSU?

Yes

No

If no, what programs have you applied to? __________________________

No
Will this be your first time attending NSU? Yes
If no, what program(s) are/have you been enrolled in? ________________
FE

Page 5 of 10

The university is required to collect the following information to comply with federal reporting requirements of the U.S.
Department of Education. The collected information will not be used in any discriminatory manner.

General Information:
__________________________________________________________________________________________________________
City
State
Country of Birth
_______
Date
of Birth (mm/dd/yy)
Sex:

Male

Female

Ethnic Origin Data:

(The provision of this information is voluntary and we request it for reporting purposes only. This information will not be used in
any discriminatory manner.)
White (not of Hispanic origin)

African American (not of Hispanic origin)

Hispanic

Native American or Alaskan Native

Asian or Pacific Islander

Other ___________________________

Veterans Information:
Have you ever served in the United States Armed Forces?

Yes

No

If yes, complete the following:

Branch of service: __________________________ Rank: ______________________________________________

Entry date: ______________ Date and type of discharge: ______________________________________________
Reserve status: ____________________________________ Are you eligible for veterans benefits?

Yes

No

If so, under what law? _____________________________________________________________________________________

_________________________________________________________________________________________________________

Citizenship Status:
Failure to complete this information may delay the processing of your financial aid and delay your matriculation should you require
certain documentation in order to attend classes in the United States.
United States citizen

Temporary resident

Permanent resident

Nonresident alien

If you are a nonresident alien, please complete the following.

_________________________________________________________________________________________________________
Country of Birth
Country of Citizenship
Is English your native language? Yes
Do you currently have a U.S. visa? Yes

No
No

If not, documentation of English literacy is required.

If yes, what type? ___________________________________

What is the expiration date? ____/____/____ (mm/dd/yy)

Do you require an I-20? Yes

No

If you have any questions, please visit our Web site: www.nova.edu/cwis/registrar/isss/.

SS# _______________________________________ Name ____________________________________________

Page 6 of 10

Applicant Email Address:

_________________________________________________________
_________________________________________________________
________________________________________________________
________________________________________________________
Email Address

Emergency Contact Information:

_______________________________________________________________________________________________________
Name:
Last
First
Relationship to You
________________________________________________________________________________________________________
Number and Street
City
________________________________________________________________________________________________________
County
State
Country
ZIP Code
_________________________________________________ ______________________________________________________
Day Telephone
Evening Telephone

Previous Education:
All official transcripts/documents are required from the applicant for ALL previously attended institutions for FULL admittance*
High school/General Education Diploma (GED) documentation is required only for undergraduate applications.
SECTION A
_________________________________________________ _______________________________________________________
Name of High School
Graduation Month and Year
_________________________________________________________________________________________________________
Number and Street
City
_________________________________________________________________________________________________________
County
State
Country
ZIP Code
General Education Diploma (GED) awarded: ______________________________
Month and Year
SECTION B

________________________
State

List ALL academic institutions (in chronological order beginning with most recent) you have, are, or will attend prior to
NSU matriculation. *Official transcripts/documents from all institutions attended are required for FULL admittance.

Name of Institution

City

State
Or
Country

Major

Approx. #
Of Credits Start and End Date
Degree Earned (or expected end)

Have you ever been required to leave any college or denied readmission because of conduct or academic deficiencies?
Yes

No

If yes, please explain.

SS# _______________________________________ Name ____________________________________________

Page 7 of 10

Checklist of Skills:
Students enrolled in the ITDE Program must be computer literate, have been online, and have a strong background in the use
of technology and/or in the fields of information/media use, technology coordination, distance education, computer
education, learning resources, or training focusing on the use of technology.
Check Yes or No for the following statements. A Yes indicates you believe you meet the entry requirement.
SECTION AInstructional Planning
Are you familiar with the design and planning of training, curriculum, and/or instruction?

Yes

No

Name at least one topic you have planned.___________________________________________________________________

______________________________________________________________________________________________________
______________________________________________________________________________________________________
SECTION BComputer Competency
For each item listed below, indicate your current skill level with 1 indicating little or no skill and 5 indicating expert skill.
____email

____wordprocessing

____presentations

____using a laptop with projector

____discussion boards

____statistical programs

____WWW in the curriculum

____listservs/newsgroups

____spreadsheets

____databases

____art/drawing/graphic design

____distance education

Are you familiar with and use at least one operating system?

Yes

No

Please identify the operating system(s) with which you are familiar. ________________________________________________
I consider myself an active user of technology.

Yes

No

Please define your current use of technology. __________________________________________________________________

________________________________________________________________________________________________________
Several competencies are required for a successful ITDE experience. Please check those skills listed below that you can currently
demonstrate.
Software Competencies

Hardware Skills

Wordprocessing

Mouse or trackball skill

Spreadsheets

Hard drive organization (folder or subdirectories)

Database management

Keyboarding

DOS or Mac operating environment

Use of common AV technology

Windows or Mac interface

(e.g., videodisc, DVD, projection devices)

Send and receive electronic mail

SECTION CTelecommunications
I have a personal computer with a modem and communications software for online access.

Yes

No

What brand of computer do you have? ________________________________________________________________________

What speed is your modem? _________________________________________________________________________________
Which communication software do you use? ____________________________________________________________________
What ISP have you used? ____________________________________________________________________________________

SS# _______________________________________ Name ____________________________________________

Page 8 of 10

SECTIONDInstructionalTechnologiesorDistanceEducation
IhaveworkedwithdistanceeducationorIhaveusedavarietyofelectronicinstructionalmediaandtechnologyinateaching,
learning,ormanagementsetting. Yes

No

Nametwoorthreeofthedifferenttypesofmediaandtechnologythatyouhaveusedand/ordescribeyourresponsibilities
inyourexperienceswithdistanceeducation._________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
SECTIONEAccomplishments
Ihavemadeatleastonesuccessfulapplicationoftechnologyordistanceeducationthathasbeendesignedtoimprovestudent
learningand/ormyteaching/training/managementskills. Yes

No

Inoneortwosentences,describethemostsignificantuseyouvemadeoftechnologyand/ordistanceeducation.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
SECTIONFAdditionalComments
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________

ProfessionalExperiences:
Listanyadditionalprofessionaland/orcareerrelatedexperiencesyouhavehad(e.g.,workshopleader,adjunctfaculty,
conferenceleader,keynoter).Pleaseattachresume.

Note:Pleasebecertaintoreadthefollowingdisclosureandsigntheapplicationforfurtherprocessing.Noapplicationwillbe
processedwithoutyoursignature.

SS#_______________________________________ Name____________________________________________ Page9of10

Haveyoueverbeenconvictedinanystateorcountryofacriminaloffense,otherthanaminortrafficoffense,whereyouhave
beenfoundguiltybyajudgeorjuryorenteredapleaofnolocontendere(nocontest);oranyjuvenileoffenses;anyoffenses
wheretherecordshavebeenexpunged;oranyconvictionthattheapplicantiscurrentlyappealing,regardlessofadjudication?

DisclosureStatement:

Yes No
Iftheanswerisyes,pleaseexplain.__________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Thedisclosureisacontinuingduty.AllapplicantsmustreporttoNovaSoutheasternUniversity(NSU)anysucharrestor
convictionafterthefilingoftheapplicationforadmissionsorduringthetimethatthestudentisenrolledatthecollege.The
admissionscommitteeandNSUwillconsidernewinformationsubmitted,andinappropriatecircumstances,maychangethe
statusofanapplicantorstudent.

PermissionisherebygiventoNSUtomakeanynecessaryinquiriesandIvoluntarilyandknowinglyauthorizeanyformer
school,governmentagency,employer,person,firm,corporation,itsofficers,employeesandagents,oranyotherpersonor
entitymakingawrittenororalrequestforsuchinformation.
SignatureofApplicant___________________________________

Date________________________________

NoticesofNondiscriminationandAccreditation

NovaSoutheasternUniversityadmitsstudentsofanyrace,color,sex,age,nondisqualifyingdisability,religionorcreed,or
nationalorethnicoriginormaritalstatusorsexualorientationtoalltherights,privileges,programs,andactivitiesgenerally
accordedormadeavailabletostudentsattheschool,anddoesnotdiscriminateinadministrationofitseducationalpolicies,
admissionspolicies,scholarshipandloanprograms,andathleticandotherschooladministeredprograms.

NovaSoutheasternUniversityisincompliancewithTitleIX,TitleVI,TitleVII,theAmericanswithDisabilitiesAct,Section504of
theRehabilitationAct,andallotherlaws,rules,orregulationspertainingtothesepolicies.

NovaSoutheasternUniversityisaccreditedbytheCommissiononCollegesoftheSouthernAssociationofCollegesandSchools
(1866SouthernLane,Decatur,Georgia300334097,Telephonenumber:4046794501)toawardassociates,bachelors,
masters,educationalspecialist,anddoctoraldegrees.

Ihavereadandunderstoodtheinstructions.Icertifythattheinformationsubmittedinthisapplicationiscompleteandcorrect
tothebestofmyknowledge.Falseand/oromittedinformationwillinvalidatethisapplicationandcouldresultinrejectionof
theapplicantordismissalfromtheuniversityiftheapplicanthasalreadybeenadmitted.PermissionisherebygiventoNSUto
makeanynecessaryinquiriesandIvoluntarilyandknowinglyauthorizeanyformerschool,governmentagency,employer,
person,firm,corporation,itsofficers,employeesandagents,oranyotherpersonorentitymakingawrittenororalrequestfor
suchinformation.IagreethatthisinformationmaybeusedbyNovaSoutheasternUniversityforresearchanddevelopment
purposesaimedatimprovingeducationandadmissionsprograms.

AcknowledgmentStatement

SignatureofApplicant___________________________________ Date________________________________

10147/04DBB
SS#________________________________________ Name________________________________________

Page10of10

Enrollment Processing Services (EPS)

Attn: Fischler School of Education and Human Services
3301 College Avenue
P.O. Box 299000
Fort Lauderdale, Florida 33329-9905
(954)
800-986-3223,Ext.
ext.28500
8500 (United
(UnitedStates
Statesand
andCanada)
Canada)
(954) 262-8500
262-8500 - 800-986-3223,
Fax # (954) 262-3608 or 3601

Recommendation for Admission

Doctor of Education
TO THE APPLICANT: This form should be completed by a professional colleague who can provide information
regarding your job performance. You must submit this recommendation form as part of the admission process.
Please complete this portion of the recommendation form before giving it to your source of reference.
Pursuant to the Family Education Rights and Privacy Act (Buckley Amendment) enacted on December 31, 1974,
I DO
I DO NOT waive the right to inspect and review this completed recommendation.

_______________________________________________

____________________________________________

Applicants name (please print)

Signature

_______________________________________________________________________________________________
Street address

Apartment

City

__________________________

________________________

Social Security number

Program

State

_________________

ZIP

___________________

Cluster

Date

Employer (or institution/organization) _________________________________________________________________

TO THE EVALUATOR: Please do not complete this form if the waiver above has not been completed and signed by
the applicant.
1. The applicants most significant strength is ________________________________________________________
____________________________________________________________________________________________
2. I have known the applicant for ______ years. The applicant has been a member of my staff for ______ years.
I have known this person:
Well
Slightly
3. In my opinion, the applicants potential for success in a doctoral program of studies is
Average
Poor
Good
4. In my opinion, the applicant has the ability to effectively complete an institutional or organizational research project.
No
Yes

SS# ____________________________________________

Name ____________________________________________

5. I have observed the applicants work on institutional or organizational projects and find the project(s)
Average
Poor
Good
6. The applicant works effectively with administrators or supervisors at his/her institution or organization.
No
Yes
7. The applicant has been involved in innovative projects at his/her institution or organization.
No
Yes
8. I have observed the applicants interpersonal skills to be
Average
Poor
Good
9. Additional comments: ________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
I have read the information above and understand that the applicant will be required to complete the practicum
research projects as a requirement in the doctoral program.
______________________________________________

______________________________________________

Date

Evaluators Signature

______________________________________________

______________________________________________

Institution or Organization

Name (please print)

______________________________________________

______________________________________________

Title

______________________________________________

Department

Please return to:

Nova Southeastern University

Enrollment Processing Services (EPS)
Attn: Fischler School of Education and Human Services
3301 College Avenue
P.O. Box 299000
Fort Lauderdale, Florida 33329-9905

SS# ____________________________________________

Name ____________________________________________

Enrollment Processing Services (EPS)

Attn: Fischler School of Education and Human Services
3301 College Avenue
P.O. Box 299000
Fort Lauderdale, Florida 33329-9905
(954)
800-986-3223,Ext.
ext.28500
8500 (United
(United States
Statesand
andCanada)
Canada)
(954) 262-8500
262-8500 - 800-986-3223,

Request for Official Transcript

Student: Complete both sections of this form. Mail to your former schools.
Please send an official transcript of my academic work while attending your institution to Nova Southeastern University.
Return the form below to Nova Southeastern University.
A. I attended your school from ________________________________ to _ ________________________________
B. While in attendance, my name on your records was __________________________________________________

Last

First

Middle/Maiden

C. My student identification number was ______________________________________________________________

D. I am enclosing the fees (if any) required by your institution.
Thank you for your assistance.
Sincerely,
_______________________________________________
Signature

Dear Alma Mater: Please return this form with the transcript. Thank you.

Transcript Transmittal Form

Social Security number ______ /____ /______

Date:_ _______________________________________________

Name_________________________________________________________________________________________
Last

First

Middle/Maiden

Address_______________________________________________________________________________________
Street

_____________________________________________________________________________________________
City

Please send to:

State

ZIP

Nova Southeastern University

Enrollment Processing Services (EPS)
Attn: Fischler School of Education and Human Services
3301 College Avenue
P.O. Box 299000
Fort Lauderdale, Florida 33329-9905

SS# ____________________________________________

Name ____________________________________________

Enrollment Processing Services (EPS)

Attn: Fischler School of Education and Human Services
3301 College Avenue
P.O. Box 299000
Fort Lauderdale, Florida 33329-9905
(954) 262-8500
262-8500- 800-986-3223,
800-986-3223,Ext.
ext.28500
8500(United
(UnitedStates
Statesand
andCanada)
Canada)
(954)
Fax:
Fax #(954)
(954)262-3601
262-3608 or 3601

Transfer of Credit Request

Instructional Site ____________________________ or

Online

Date _________________________________________
Name of
Academic Institution you are Requesting Transfer of Credit
Name_
________________________________________________________________________________________

Name

__________________________________________________________________________________________
Last

First

Middle/Maiden

Address_______________________________________________________________________________________
Street

__________________________________________________________________________________________
City

State

ZIP

Social Security number ________________________________________________

Email address _______________________________________________________

NOTE: Applicants must file for this transfer review at the time of application.
Name of courses and number of credit hours requesting to be transferred. (Official transcripts and catalog description
of courses must be attached to request.) Identify the course title in the program that you wish the transfer credit to replace.
Title of Transfer

Course(s)

Number of Title of Replacement

Credit Hours
Course(s)

SS# ____________________________________________

Number of
Credit Hours

Name ____________________________________________