Fillable DUAL CREDIT ASSISTANCE APPLICATION (North Dakota State College of Science)

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DUAL CREDIT ASSISTANCE APPLICATION (North Dakota State College of Science)

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DUAL CREDIT ASSISTANCE APPLICATION
BANK OF NORTH DAKOTA
COLLEGE PLANNING CENTER
SFN 60348 (04-2019)
Bank of North Dakota (BND) is accepting applications from eligible students for financial assistance to pay for dual credit courses. Funding may
be limited. Applications will be considered by date submitted. Approved students may receive assistance for up to two (2) courses per academic
school year. See Page 2 for eligibility, instructions and application process, and other important information.
Bank of North Dakota | PO Box 5509 | Bismarck, ND 58506-5509 | 800.554.2717 | TTY: 800.366.6888 | FAX: 701.328.5629
STUDENT INFORMATION
Student Legal Last Name First Name Middle Initial
Mailing Address City State
ZIP Code
Email Address Student Telephone Number (include area code)
Year in School (grade when class will be taken)
10 11 12
Date of Birth (mm/dd/yyyy)
Name of High School Attending*
Mailing Address City State
ZIP Code
Student Signature
Parent/Guardian Signature
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
* If student is completing a home education program, please list "Home Educated" or name of home school in this field.
COURSE 1
College Course Title College Course Number
College Semester Hours (check one)
2 3 4 5
Name of College/University Where Course is to be Credited
Mailing Address City State
ZIP Code
School Year Course will be Taken (example: 2019-2020)
School Semester Course is Taken (check one)
Fall Spring Summer
COURSE 2
College Course Title College Course Number
College Semester Hours (check one)
2 3 4 5
Name of College/University Where Course is to be Credited
Mailing Address City State
ZIP Code
School Semester Course is Taken (check one)
Fall Spring Summer
School Year Course will be Taken (example: 2019-2020)
TO BE COMPLETED BY SCHOOL OFFICIAL
Superintendent or Designee Name
Title of Designee
Email Address
Certify Applicant is ELIGIBLE for Free or Reduced Price Lunch (check one)
Yes No
Telephone Number (include area code)
Superintendent or Designee Signature
Date (mm/dd/yyyy)
Important: Complete all fields for course(s) taken or processing will be delayed!
SFN 60348 (04-2019)
Page 2 of 2
Bank of North Dakota | PO Box 5509 | Bismarck, ND 58506-5509 | 800.554.2717 | TTY: 800.366.6888 | FAX: 701.328.5629
Eligibility and Assistance Highlights
To be eligible, a student must:
1. Be a current sophomore, junior or senior attending a North Dakota high school, or student completing a North Dakota home
education program.
2. Receive authorization from high school to take approved dual credit course.
3. Qualify for free or reduced price lunch.
4. Submit application for assistance to BND during the course enrollment process.
Costs covered by assistance:
1. Application fee (if applicable)
2. Tuition and fees
3. Books (with shipping costs, if applicable)
4. Assistance will be reduced by waivers or other assistance student receives.
5. Student may not receive assistance to retake a course.
Instructions and Application Process
1. Student attending a North Dakota high school work with a school official and/or or parent/guardian to complete the application.
2. Student completing a North Dakota home education program work with a parent/guardian to complete the application. To verify
eligibility, submit the first two pages of parent/guardian's federal tax return.
3. Important: Complete all fields for course(s) taken or processing will be delayed!
4. Submit application for assistance to BND during the course enrollment process and meet the fall, spring and summer submission
application deadlines to BND (see below).
• Fall - January 31*
• Spring - June 30*
• Summer - September 30*
* Note: If the deadline date falls on a weekend, the Friday prior to that date is the deadline date.
5. Mail, fax or email completed application to:
Bank of North Dakota
Dual Credit Assistance
PO Box 5509
Bismarck, ND 58506-5509
FAX: 701.328.5629
Email: cpcgrp@nd.gov
Call 800.554.2717 or email cpcgrp@nd.gov
if you have questions.
6. After applications are received at BND, student will be sent notification of approval or denial for assistance.
7. The college campus will be notified to bill BND directly for application fee, tuition, fees and books less waivers or other assistance.
8. All assistance will be paid directly to the college campus through which the dual credit course is being taken. In the event of an
overpayment to the college, any funds will be returned to BND.
Assistance is not a loan; therefore, approved student will not be asked to repay funds.
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DUAL CREDIT ASSISTANCE APPLICATION (North Dakota State College of Science)

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Completed 26 July 2020

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