Readmission App / Reverse Transfer :: Dakota College at Bottineau

Students who have left school and would like to either be readmitted or would like to receive a degree needs to fill out this form.

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.

First Name *

Middle Initial *

Last Name *

Date of Birth *

Place of Birth *

Are you a ND Resident? *

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

Student ID # *

Email Address *

Confirm Email Address *

Phone *

Gender *

**Race

If No, which state do you hold citizenship?

If Yes, Length of Residency?

Alien Registration #

When did you last attend DCB? *

Degree Program *

Award Seeking *

Please list schools attended since leaving DCB

Did you visit with a DCB contact prior to completing this form?

Yes

Contact Name

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

Applicant's Initials Required *