Master's Degree Application Form AY2021_revised

OMB CONTROL NUMBER: XXXX-XXXX
OMB EXPIRATION DATE: XX/XX/XXXX

NATIONAL DEFENSE UNIVERSITY
University Registrar’s Office
MASTER’S DEGREE APPLICATION FORM
FOR INTERNATIONAL STUDENTS

Privacy Act Statement
Authority: 10 U.S.C. §2163 (Degree Granting Authority for National Defense
University); 10 U.S.C. §2165 (National Defense University).
Purpose: Information is collected as application for admission to an NDU
master’s degree program.
Routine Use: Information will be disclosed within NDU for admissions
purposes, and submission of this application constitutes your permission to do
so. The applicable system of records notice is located at: https://
dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/
Article/570570/dndu01/.
Disclosure: Voluntary; however, failure to provide the information may
result in denial of admission to an NDU master’s program.
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, XXXX-XXXX, is
estimated to average 15 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or burden
reduction suggestions to the Department of Defense, Washington
Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-informationcollections@mail.mil. Respondents should be aware that notwithstanding any
other provision of law, no person shall be subject to any penalty for failing to
comply with a collection of information if it does not display a currently valid
OMB control number.

LEGAL NAME:
_______________________________
___
__________________
_
______________________________________________________
Last/Family/Surname

First

Middle

HOME COUNTRY: __________________________ TITLE/RANK & BRANCH OFSERVICE:____________________________

APPLICATION FOR:

□ M.A. in Strategic Security Studies (CISA students)
□ M.S. in Government Information Leadership (CIC students)
□ M.S. in Joint Campaign Planning and Strategy (JAWS students)
□ M.S. in National Resource Strategy (ES students)
□ M.S. in National Security Strategy (NWC students)
EDUCATIONAL BACKGROUND
__ Undergraduate Degree

__ Graduate Degree

__ Short Term Study

Institution: ______________________________________Title of Degree/Credential Earned:__________________________
Attendance- Start Date: ____________________________ End Date/Date of Graduation: ____________________________
Major/Course of Study/Specialization: ______________________________________________________________________
Applicable notes for this course of study: ___________________________________________________________________
_____________________________________________________________________________________________________
__Undergraduate Degree

__ Graduate Degree

__ Short Term Study

Institution: ______________________________________Title of Degree/Credential Earned:__________________________
Attendance- Start Date: ____________________________ End Date/Date of Graduation: ____________________________
Major/Course of Study/Specialization: ______________________________________________________________________
Applicable notes for this course of study: ___________________________________________________________________
_____________________________________________________________________________________________________

__Undergraduate Degree

__ Graduate Degree

__ Short Term Study

Institution: ______________________________________Title of Degree/Credential Earned:__________________________
Attendance- Start Date: ____________________________ End Date/Date of Graduation: ____________________________
Major/Course of Study/Specialization: ______________________________________________________________________
Applicable notes for this course of study: ____________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
__Undergraduate Degree __ Graduate Degree

__ Short Term Study

Institution: ______________________________________Title of Degree/Credential Earned:__________________________
Attendance- Start Date: ____________________________ End Date/Date of Graduation: ____________________________
Major/Course of Study/Specialization: ______________________________________________________________________
Applicable notes for this course of study: ___________________________________________________________________
_____________________________________________________________________________________________________
OTHER DIPLOMAS, SCHOOLS ATTENDED OR CERTIFICATIONS (FILL IN AS NECESSARY FOLLOWING FORMAT AS ABOVE.)
_______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

ENGLISH PROFICIENCY:

□ I already took the TOEFL examination on (date) ____________ Score_____________
□ I will register for and take the TOEFL before

the 1 October deadline.

□ I believe I am exempted from the TOEFL exam per the annual DSCA memorandum. □URO CONFIRMATION
INSTRUCTIONS:
You are responsible for providing copies of all academic credentials listed above in their native language and with English translations as
necessary. You must also provide a resume detailing the chronology of your experience and education.

Student’s Signature__________________________________________________Date ________________________