Registration & Records: Veterans Services

*Student Name:
Student ID Number:
Date of Birth:	mm-dd-yyyy
*E-mail Address:

Address 1:
Address 2:
City:
State/Province:
Country:
Zip/Postal Code:
Phone:

Guard Unit:
Guard Unit State:

*Are you a North Dakota resident?	Yes No *If yes, length of residency: If no*, state of residence:
*Semester & Year you plan to return to NDSU:	example: Summer 2008
*Are you seeking a degree from NDSU?	Yes No *If yes*, list major:
Do you plan to apply for financial aid?	Yes No *If yes*, please apply online at http://www.fafsa.ed.gov/
Do you plan to apply for on campus housing?	Yes No

*Have you attended any other colleges or universities, including online classes, since you last attended NDSU?	Yes No
*If yes*, list all institutions attended and dates of attendance at each:

All students making application to North Dakota State University MUST ANSWER THE FOLLOWING QUESTIONS. An affirmative response to any of the questions will not automatically prevent admission, but you will be asked to provide additional information. The information will be reviewed by a campus committee. Falsification or omission of information may result in a denial of admission, recission of admission, dismissal or other appropriate sanctions.

* Have you ever pled guilty (or no contest) to or been convicted of a felony? (This excludes juvenile court proceedings.)

No
Yes (if yes, please indicate ALL states, cities, counties and dates of convictions)

State		City		County		Date	(mm-dd-yyyy)
State		City		County		Date	(mm-dd-yyyy)

* Within the past 10 years, have you pled guilty (or no contest) to or otherwise been convicted of a misdemeanor crime involving a crime of violence or the threat of violence in any criminal court? (This excludes juvenile court proceedings.) "Crime of violence" means an offense in which physical force was either used, attempted, or threatened against the person or property of another or by nature of the offense it 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.

No
Yes (if yes, please indicate ALL states, cities, counties and dates of convictions)

State		City		County		Date	(mm-dd-yyyy)
State		City		County		Date	(mm-dd-yyyy)

* Are you currently required to register as a sex offender in any State? (This includes juvenile offenders who are required to register.)

No
Yes (if yes, please indicate ALL states, cities, and counties where registration is required)

State		City		County		Date	(mm-dd-yyyy)
State		City		County		Date	(mm-dd-yyyy)

* Have you been dismissed or suspended from a college or university for disciplinary reasons within the last 5 years? (This excludes suspensions based on academic performance.) "Dismissed for disciplinary reasons" means a permanent separation from an institution due to conduct or behavior. "Suspension for disciplinary reasons" means a sanction imposed for disciplinary reasons that results in a student leaving school for a fixed period, but not permanently.
No
Yes (if yes, please indicate institution and date of dismissal)

Institution Date (mm-dd-yyyy)

If you answered "yes" to any of the above, please write and send a personal narrative explaining the nature of the offense(s) and surrounding circumstances to RaNelle Ingalls, Associate Registrar, at ranelle.ingalls@ndsu.edu. A "yes" answer to any of the above questions may require additional documentation which must be recevied 30 days prior to the term for which you areseeking admission.

Returning Military Re-Enrollment Form