Bismarck State College
Request to be a Collaborative Student
Bismarck State College, P.O. Box 5587, 1500 Edwards Avenue, Bismarck, ND 58506    701-224-5400 :: 800-445-5073
These are the steps that you will need to complete to register as a collaborative student:
  1. Complete the Request to be a Collaborative Student form below.
  2. After BSC receives your request form, we will check to make sure that you are eligible to take these courses collaboratively.
  3. BSC will then give the provider campus permission to register you for the classes you requested.
  4. You will receive a confirmation email within 2 weeks after the registration has been completed.
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* First Name:
* Middle Initial:
* Last Name:
* EMPL (Student) ID: 
* Date of Birth (ex:01/01/1900):
* Current Mailing Address:
  (do NOT enter email address)
* City:
* County:
* State:
* Zip Code:
Country (if other than U.S.):

Do you now or have you live(d) in North Dakota?   Yes    No      If yes, list years (e.g. 1900-present or 1990-2009):
If no, or not currently a ND resident, in what state are you a resident?     List years (e.g. 1997-present):  
If you have lived in ND less than one year, in what state did you most recently reside? List years (e.g. 1997-present):

* Primary Phone (area code):   * Phone Type: Secondary Phone (area code):   Phone Type:
* Campus Email Address:     * Institution where you will receive your degree:
* Are you participating in any third party arrangements to pay your tuition and fees    Yes No
  (i.e. military tuition assistance, voc rehab, job service, etc.)?
* Semester you wish to enroll for:     
* School that you want to take a collaborative course from, your Provider
   institution. (You need to complete a request form for each school.)

* Collaborative Request #1

 

* Class Nbr:
* Course Title:
* Subject and Catalog Nbr
  (i.e. ENGL 110):
* Semester Hours:

* Delivery Method:


Collaborative Request #2

 

Class Nbr:
Course Title:
Subject and Catalog Nbr
(i.e. ENGL 110):
Semester Hours:

Delivery Method:


Collaborative Request #3

 

Class Nbr:
Course Title:
Subject and Catalog Nbr
(i.e. ENGL 110):
Semester Hours:

Delivery Method:


Collaborative Request #4

 

Class Nbr:
Course Title:
Subject and Catalog Nbr
(i.e. ENGL 110):
Semester Hours:

Delivery Method:


* Signature: I have read and understand all criteria and deadlines as presented on this page. I certify that all statements in this registration are true to the best of my knowledge. I also authorize my * home institution: to email my EMPLID # to the provider institution I have chosen. This is just a request and I understand that my registration is not completed until I receive confirmation from the provider institution. * Check if you agree:  
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