You must have JavaScript enabled to use this form. Student Contact Information Name Previous Name(s) if applicable Date of Birth address Street Address City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Zip Code Email Phone Have you taken courses through Doane University in the past? - Select -YesNo Undergraduate Degree Information Institution where you earned your bachelor's degree Location of institution Date awarded I am interested in attending as - Select -a non-degree-seeking studenta degree-seeking Curriculum and Instruction studenta Crete student moving into the Curriculum and Instruction program Course Selection Type your course selections with one per line. Course Number and Section - Title - Location - Semester Acknowledgement and Signature I acknowledge completing this form obligates me to pay all tuition, course fees, and applicable late payment charges to Doane University. I acknowledge failure to pay or to complete the course does not mean I will be dropped from this course. I acknowledge I must contact the college of education graduate office for any registration change or drop at 1-888-803-6263. Signature *NOTE: A confirmation email will be sent to the email address you provided above within 7-10 days of receipt of this form. This email will include payment information for the course. Failure to pay prior to the first day of the course may result in a registration hold for future semesters.
