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South Dakota Center for Farm/Ranch Management
FSA Borrower Training Registration Form
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* Indicates required question
NAME
*
(Last Name, First Name, Middle Initial)
Your answer
PERMANENT ADDRESS (Complete)
*
(Street Address, CITY, STATE, ZIP CODE
Your answer
PHONE NUMBER
*
(Home)
Your answer
PHONE NUMBER
*
(Cell)
Your answer
DATE OF BIRTH:
*
DD/MM/YYYY
Your answer
EMAIL ADDRESS:
*
Your answer
GENDER
*
FEMALE
MALE
HISPANIC
*
YES
NO
RACE:
*
AMERICAN INDIAN OR ALASKA NATIVE
ASIAN
BLACK OR AFRICAN AMERICAN
NATIVE HAWAIIAN OF OTHER PACIFIC ISLANDER
WHITE
Have you ever attended Mitchell Technical Institute before?
*
YES
NO
Have you ever attended another college or technical institute?
*
YES
NO
COURSE SELECTION:
*
FBM 100 - Beginner Farmer/Rancher FSA Borrower Training
Choose
Online
In Person - Mitchell
Rapid City, 2016
STUDENT SIGNATURE:
*
(Typing below and submitting form indicates your signature)
Your answer
DATE:
*
MM
/
DD
/
YYYY
Tuition and Fees - 4 Credit Course - $600.00
*
Course can by paid by check or credit card. Course work cannot begin until payment is made.
Check - Mail to Mitchell Technical Inst., Attn: Corporate Education, 1800 E Spruce St. Mitchell, SD 57301
Credit Card - Call 605-995-3056
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