Special Education Technician Enrollment Form

The North Dakota Department of Public Instruction
has made this scholarship possible.

2023-2024 Scholarship Program - Deadline September 1, 2023

Please fill out the form below and click the submit button at the bottom of the page.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email - Please use your primary email address through which all course correspondence will take place. *

Date of Birth *

Name of School *

Name of Special Education Director *

Upload proof of a recent background check or in the absence of a background check, you can upload a letter from your administrator that serves as an attestation statement that states you if fact do have a clear criminal history record. *

Click or drag files to this area to upload. You can upload up to 2 files.

If you have any Postsecondary Transcript to be reviewed, you can upload them here. (Optional)

Click or drag files to this area to upload. You can upload up to 5 files.

Attestation - Please read and check the boxes below to confirm that the following statements are understood. *

I understand the Special Education Technician program is self-paced and is a 42-credit equivalent.
I understand the scholarship is for tuition, and I am responsible for the cost of textbooks.

The North Dakota Department of Public Instruction has made this scholarship possible.

2023-2024 Scholarship Program - Deadline September 1, 2023

Please fill out the form below and click the submit button at the bottom of the page.

The North Dakota Department of Public Instruction
has made this scholarship possible.