Continuing Enrollment Form :: Dakota College at Bottineau

First Name *

Middle Initial *

Last Name *

Date of Birth *

Place of Birth *

Are you a ND Resident? *

Student ID # *

Email Address *

Confirm Email Address *

Phone *

Gender *

**Race

Entry Term *

Year *

Award Seeking *

Degree Program *

Location, Delivery Method

On Campus

Online

Off Campus

All students making application 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, then, will be reviewed by a campus officer or committee charged with that responsibility. Fabrications or omission of information may result in a denial of admission, revocation of admission, dismissal, or other appropriate sanction.

Have you ever pled guilty (or no contest) to or been convicted of any felony? *

Yes

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.

Misdemeanor Crime *

Yes

Are you currently required to register as a sex offender in any state? *

Yes

Have you been dismissed or suspended from a college or university for disciplinary reasons within the past 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.)

Yes

I certify that all statements in this application are complete and true.

Do you agree? *

Yes

Applicant's Initials Required *

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.

** Items preceded by an asterisk are 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 questions.