Registrar's Office

Collaborative Application

If you are a student planning to take collaborative courses please fill out the following form to bring to the registration process.
First name:		Middle initial:

Last name:		ID number:

Mailing address:		City:

State:

Zip:

Phone number:

E-mail address:

Birth date:
	(mm/dd/yyyy)
Place of birth:

Are you a North Dakota resident?

If yes, length of residency?

If no, state of residency?

If no, in which country do you hold citizinship?

If not a United States citizen, are you a permanent resident?

Term you plan to enter:

Year:

Have you ever taken a course from NDSCS before?

From which College or University do you want to take collaborative courses?


Please list the following course information you will be taking at host campus:

Class number:		Course Title:
Catalog number:		(ex. BIOL 115)
Credit hours:
Delivery method:

Class number:		Course Title:
Catalog number:		(ex. BIOL 115)
Credit hours:
Delivery method:

Class number:		Course Title:
Catalog number:		(ex. BIOL 115)
Credit hours:
Delivery method:

Class number:		Course Title:
Catalog number:		(ex. BIOL 115)
Credit hours:
Delivery method:

I have read and understand all the criteria and deadlines as presented on the previous collaborative registration page. I certify that all statements in this registration are true to the best of my knowledge.
Initials: