Admission office

Re-application Form

This form should be filled out only if you have applied for or attended classes at NDSCS.

Date:

(mm/dd/yyyy)

NA/ID number:

Legal name:

First name: *

Middle name:

Last name: *

Former name - if applicable

Student's e-mail address:

Students' mailing address:

Street:

Apartment number:

City:

State:

Zip:

County:

Country - if not U.S.A.

Phone number:

Name of parent or guardian:

Permanent or parent or guardian address:

Address - Street:

Country - if not U.S.A.

City:

State:

Zip:

Student date of birth:

(mm/dd/yyyy)

City:

State:

County:

Country - if not U.S.A.

Are you a member or Veteran of the Armed Services?

If yes, will you apply for benefits?

Are you an active member or a dependant of an active member of the military stationed in North Dakota?

Are you the spouse or dependent of a graduate of a North Dakota Public Institution?

If yes, which Institution?

Are you a North Dakota resident?

If yes, length of residency:

If no, state of residency:

Are you a U.S. Citizen?

If no, which Country do you hold citizenship?

If not a U.S. Citizen, are you a permanent resident?

If yes, provide your alien registration number:

* Race:

* Gender:

Year you plan to enter NDSCS? *

(yyyy)

Term: *

Academic options (majors): *

(CTRL to select multiple choices.)

Indicate the date you took or plan to take either the ACT or SAT.

ACT: SAT:

High school name:

The last high school you attended and Gradutation date:

GED - high school equivanlency exam completion date:

Have you attended or are you currently enrolled in any other colleges or universities?

List all colleges, universities and schools beyond high school you attended, whether or not credit was earned.

Failure to list all colleges, universities and schools previously attended may result in denial of admission, revision of admission, dismissal, loss of credit(s), or other appropriate sanctions.

Name	Location (City, State)	Inclusive dates of attendance	Degree earned and date

* Items preceded by an asterisk are completed voluntarily and do not affect the status of your application; however, this information is frequently requested by the North Dakota University System Colleges and Universities and by both state and federal agencies for statistical purposes, and you are strongly urged to complete this section. Also, to receive information about the cultural diversity tuition waiver, it is recommended the applicant complete these sections.

It is the policy of the NDUS that no person in the United States shall be discriminated against because of race, religion, age, color, gender, disability, or national origin, and the equal opportunity and access to facilities shall be available to all.

I CERTIFY THAT ALL STATEMENTS IN THIS APPLICATION ARE COMPLETE AND TRUE:

Applicant's Initials (in lieu of signature) required:

Today's date: