General Information

Name ________________________________________________

Address ___________________________________________________________________________________

Street Apt. ZIP

Home Telephone ( )______________________

Fax ( ) _______________________ E-mail address__________________________________
 
 

Employer ___________________________________________________________________________

Business Address _____________________________________________________________________

Street and Number

_____________________________________________________________________

City State ZIP
 
 

Business Telephone ( ) _____________________________

Professional Information

1. Present Position (job title) ____________________________________________________________


Job Responsibilities (include specific function and level):

__________________________________________________________________________________
 
 

__________________________________________________________________________________

2. Area of Specialization.
3. 
    

    
    
    
    
    
    

4. List other professional and/or career-related experiences you have had.
5. 
    

    
    
    
    
    
    
    
    
    
    
    
    

6. Indicate your career goal.


___________ Public or Private Schools

___________ Government Agencies

___________ Medical or Health or Hospitals

___________ Business and Industry
 

7. Supply a letter regarding your interest in the field of Educational/Instructional Technology, incorporating the following points as the basis for your statement (attach additional pages):

• How you conceptualize educational technology in relation to other areas of work?
• When and why did you decide that you wanted to pursue study in the field of instructional technology?
• Why do you feel you will be successful in an instructional technology program?
• What challenges or limitations do you anticipate in completing this program?
• How will program completion contribute to your career enhancement?

Acknowledgement of Program Requirements:

I understand that the broad requirements for the program include passing each of the study areas, successfully completing a sequence of Colloquium, internship and thesis or portfolio development.

I declare that the above information, to the best of my knowledge, is complete and accurate. I agree to abide by all rules and regulations of University of North Carolina at Wilmington.

Name (please print)_____________________________________________ Soc. Sec. # _______________

Signature ____________________________________________________ Date _____________________

Mail this completed supplementary application and narrative response to:
Master Science in Instructional Technology Program Coordinator
Department of Specialty Studies
UNCW Watson School of Education
601 South College Road
Wilmington, NC 28403-3297

Checkist of Skills

Name ______________________________

Students enrolled in the MIT program must be computer literate, be proficient in using the Internet or World Wide Web, and have mastered North Carolina essential and advanced technology competencies. Individuals entering the program with limited or no computer experience will be required to take EDN 303 (or equivalent courses) or pass the performance competencies test for EDN 303.

Instructions: Write "yes" or "no" before each of the following statements. A "Yes" indicates you believe that you meet that entry requirement.

Area I: Computer Competencies

_______ I possess basic competencies in using word processing software. (Indicate which software you have used.)

_______ I possess basic competencies using spreadsheet or data analysis applications. (Indicate which software you have used.)

_______ I possess basic competencies using Internet or World Wide Web.
 
 
 
 
 
 

_______ I have ability and experience with file management (saving, moving, copying, downloading, etc.)
 
 
 
 
 
 
 
 

_______ I have used and am familiar with database software. (Indicate which software you have used.)
 
 

Area II: Instructional Design and Development

_______ I am familiar with the design and planning of training, curriculum, and/or instruction. Name at least one topic you have planned.

Area III: Telecommunications

_______ I have a personal computer with a modem and communication software for online access.

What brand of computer do you have? What size is the capacity of your hard drive? What speed is your modem? Have you been online? Which communication software do you use? If so, what service have you used?

Dr. Edna H. Mory
Last updated 11/17/99