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| Legal name: |
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| First name: * |
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| Middle name: |
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| Last name: * |
Former name - if applicable |
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| Student's e-mail address: |
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| Students' mailing address: |
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| Apartment number: |
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Country - if not U.S.A. |
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| Phone number: |
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| Name of parent or guardian: |
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| Permanent or parent or guardian address: |
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Country - if not U.S.A. |
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| Student date of birth: |
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Country - if not U.S.A. |
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| Are you a member or Veteran of the Armed Services? |
If yes, will you apply for benefits? |
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| Are you an active member or a dependant of an active member of the military stationed in North Dakota? |
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| Are you the spouse or dependent of a graduate of a North Dakota Public Institution? |
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| If yes, which Institution? |
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| Are you a North Dakota resident? |
If yes, length of residency:
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If no, state of residency:
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| Are you a U.S. Citizen? |
If no, which Country do you hold citizenship? |
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| If not a U.S. Citizen, are you a permanent resident? |
If yes, provide your alien registration number: |
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| * Race: |
* Gender: |
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| Year you plan to enter NDSCS? * |
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(yyyy) |
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| Term: * |
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| Academic options (majors): * |
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(CTRL to select multiple choices.) |
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| Indicate the date you took or plan to take either the ACT or SAT. |
ACT:
SAT: |
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| High school name: |
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| The last high school you attended and Graduation date: |
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| GED - high school equivalency exam completion date: |
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| Have you attended or are you currently enrolled in any other colleges or universities? |
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| 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. |
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| * 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. |
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| 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. |
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| Students who are making reapplication to NDSCS are required to complete the following questions as part of the application process. Please complete the following required information and resubmit to NDSCS Enrollment Services. |
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| Required Additional Information |
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| All students making application and or reapplication must answer the following questions. An affirmative response to any of these questions will not automatically prevent admission, but you will be asked to provide additional information. The information will be reviewed by a campus officer and or committee charged with that responsibility. Falsification or omission of information may result in a denial of admission, rescission of admission, dismissal, or other appropriate sanction. |
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| 1. Have you ever pled guilty (or no contest) to or been convicted of any felony? |
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| 2. Within the past 10 years, have you pled guilty (or no contest) to or otherwise been convicted of a misdemeanor crime involving violence or the threat of violence in any court? (“Crime of violence” means an offense that involves substantial risk that physical force may be used against a person or property of another. Examples of crimes of violence include, but are not limited to, abuse, arson, assault [including sexual assault or domestic violence], battery, breaking and entering, burglary, criminal mischief or vandalism, harassment, homicide, menacing, reckless endangerment, stalking, terrorizing and unlawful restraint or imprisonment). |
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| 3. Are you currently required to register as a sex offender in any state? |
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| 4. Have you been dismissed or suspended from a college or university for disciplinary reasons within the last 5 years? (“Dismissed for disciplinary reasons” means a permanent separation from an institution due to conduct or behavior. “Suspended for disciplinary reasons” means a sanction imposed for disciplinary reasons that results in a student leaving school for a fixed period but not permanently.) |
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| Go to http://www.ndus.edu/uploads/ndus-policies/P511.pdf to view the list of NDUS academic programs which require further criminal history background checks. These may include nationwide FBI criminal history background checks or a criminal history background check which may be a North Dakota BCI check, nationwide check or check of another state or multiple jurisdictions. |
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| Reguired Signature |
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| I understand the information presented on this form will be used in evaluating my application for admission to North Dakota State College of Science. I certify that all statements are complete and true as of this date. If this information changes, I will notify the Admission/Enrollment Services Office of the changes and understand that my admission status will be reevaluated at that time. |
This form must be received 30 days prior to the start of the term to be considered for admission. Form should be resubmitted to:
NDSCS Enrollment Services, 800 6th Street N, Wahpeton, ND 58076.
Should you have questions related to the requested documentation please contact NDSCS Enrollment Services at 1-800-342-4325 x.3-2202. |
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| I CERTIFY THAT ALL STATEMENTS IN THIS APPLICATION ARE COMPLETE AND TRUE: |
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| Applicant's Initials (in lieu of signature) required:
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Today's date: |
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