DSU Extended Programs
Course Registration Request Form

About SSL Certificates

This is not an application for admission to a degree program.  This is a request form to register for an online or campus course.

Please fill in this form completely, read the ACCESS note at the end of the registration, and use the Submit button to send your registration. Information on this form will be checked for completeness when you submit it. If there are any problems found during processing, you will be given an error message that describes the problems. Please try to correct the errors based on the message and re-submit the form. If you receive an error message when you believe your submission is correct, please send an email to dsuinfo@dsu.edu and tell us the nature of the problem, including the Web browser (such as Microsoft Internet Explorer, Mozilla Firefox) you are using and the content of the error message.

Note:  red start * indicates required field

          Your Personal Information

. Last Name:*  .
First Name:*  
Former Name:
Street Address*
City*  County (if SD resident)
State/Province* Zip Code:*
Birth Date* (mm/dd/yy) Social Security #:
Telephone #:*
Email Address:*  (must be a valid one)
Name of High School Attended
School City and State:
Date of High School Graduation: (mm/yy)
If not high school graduate, date of GED:
Have you applied to DSU before: No   Yes
Are you currently enrolled in a degree program?  If yes, please list which program you are accepted in.
Have you ever attended another college or university? No    Yes
If yes, please specify the college name, location, and years of enrollment:

If you received a degree, please specify the degree:


Have you ever been dismissed, or suspended, from any college, university, or post secondary institution? *
No   Yes
If yes, state when and for what reason:
Are you currently enrolled in another institution of higher education? 
No   Yes
If yes, state which institution of higher education you are enrolled in:

Your Residency *         

Are you a U.S. citizen?*  Yes. No.
Are you a permanent resident?*  Yes. No.
If you are neither U.S. citizen nor permanent resident, what's your visa status?
Have you lived in South Dakota for the past 12 months?*  Yes. No.
If no, what's your state of residence?
Where will you be taking courses?*    On campus Off campus.
If you are a United States citizen, do you certify under oath that you are registered with the Selective Service pursuant to the Military Selective Service Act 50 USC 453 as amended and in effect on January 1, 1988 or that for any reason specified in 50 USC453 you are not required to be registered? *
No. Yes. 
The following is required for Civil Rights/Affirmative Action reporting purposes:
Gender:* Male  Female
Ethnic Group/Race:*   
  White  Black  Asian  Native American    Hispanic Other
Please Note: By returning this form, you certify that, to the best of your knowledge, the information furnished is complete and accurate, and you agree to submit only your own work as completed assignments for the course, and you agree to not give or send any materials, data, or assignments for the course to others, except as directed by the professor. 


SDePay Online Payment & Billing

Students can retrieve their billing statements online and make a payment through WebAdvisor with either an electronic check or a credit card as part of SDePay.

Features and Benefits

  • eBill (online statement) notification sent to your official DSU assigned email address.
  • View your current bill, payment history and up to 16 months of statements online anytime, anywhere for your convenience. Students are encouraged to review their student account regularly as a matter of good business practice.
  • Pay your bill electronically via SDePay with:
  • eCheck - automatic debit from checking or savings account
  • or
  • Credit Card - MasterCard, Discover, or American Express (subject to 2.75% service charge) VISA is not accepted.
  • Authorize parent/guardian/spouse to vie your statements and make payments on your behalf

For further information regarding Online Payment and Billing, please refer to the following website: http://www.dsu.edu/cashier/documents/SDePay-Brochuure-Information-April-2010.pdf

More information is also available on the Cashier's website: http://www.dsu.edu/cashier/index.aspx

You may also send an e-mail to: dsuinfo@dsu.edu for further information.

2013 Extended Programs. All Right Reserved

Update Time July 10, 2013