BHSU: Non-Degree Seeking Application
Student Contact Information
First Name (full, legal)
Middle Name
Last Name
Preferred First Name
Former/Maiden Last Name(s)
Date of Birth
Email
Phone/Mobile
Permanent Mailing Address
Permanent Mailing City
Permanent Mailing State
Permanent Mailing Zip/Postal Code
Emergency Contact Information
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone
Emergency Contact Email
Relationship to You
Please select...
Parent
Legal Guardian
Spouse
Other/not listed
Academic & Residency Information
Have you lived in South Dakota for the past 12 months?
Yes
No
If you are a South Dakota resident, but you have not lived in South Dakota for the past 12 months, please explain.
When/Where did you last take classes from a South Dakota public university?
Semester and year you wish to re-enroll:
Summer 2024
Fall 2024
Spring 2025
Which campus/location do you plan to take most of your classes:
Please select...
Spearfish main campus
BHSU-Rapid City (university center)
Internet/Online
Ellsworth AFB
If you wish to register for a
specific
BHSU course(s) or section, please list it here.
Certification of Accuracy
All answers I have given on this form are complete and accurate to the best of my knowledge. I understand that a readmission decision will be based on the information provided herein and other relevant academic and administrative information.
I agree
Signature (type your full, Legal Name, in the box below.