APPLICATION FOR ADMISSION
PLEASE TYPE OR PRINT (web application):
A non-refundable application fee of $20 must accompany this application.
Institution to which you are applying:
Were you previously enrolled at
Dates of regular enrollment ____________________________
And/or Dates of continuing education or extension enrollment __________
□ Fall semester, 20____ □ Spring semester, 20___ □ Summer semester, 20____
PLEASE INDICATE:
□ Associate degree/certificate (indicate program) ___________________________
□ Non-degree
undergraduate (not pursuing a degree or certificate at this institution)
□ For personal/professional development
□ For transfer to another institution (specify plans) _____________________
□ For subsequent use toward an undergraduate program at this school
□ Other_______________________________________________________
□ Non-degree
graduate (bachelor degree earned/not pursuing a graduate program at this
institution.
□ For teacher certification
□ For transfer to another institution (specify plans) _____________________
□ For personal/professional development
□ To satisfy graduate school deficiencies
□ Other _______________________________________________________
Full legal name:
____________________________________________________________________
Last
First M.I.
Previous last name(s)
__________________________________________________
Social Security Number
________________________________________________
We ask you to voluntarily
provide this number which permits the school to distinguish between
individuals of the same or similar names. This is especially important should
you request a transcript at a later date or wish to be considered for
financial aid. The number may also be used as your student ID should you
enroll. You will not per penalize should you decline to provide your social
security number.
Permanent Address
___________________________________________________
___________________________________________________________________
(if
Telephone number ( ) ____________ Cell phone ( ) _____________
Mailing Address
______________________________________________________
____________________________________________________________________
Telephone number ( ) ____________
Birthdate _______/_______/________ Birthplace ___________________________________
Country of citizenship ____________________________________________________________
If not in
If you are or will be a high
school graduate, please indicate:
Graduation date: _________________
Complete high school name
_________________________________________________________
City/State ____________________________ Is this high school accredited by its state
department
or office of education? □ Yes □ No
If you have or will receive a
GED, please indicate date and location _______________________________
If you have attended or are
attending a college or university, please provide the following information
for each institution, whether or not credit was earned:
Complete school name Location Attendance period Degree/credits earned
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Were you ever
suspended/dismissed for academic reasons from any of the institutions listed
above?
□ Yes □ No If yes, please describe _________________________________________________
For the two years prior to
the desired term of enrollment, will you have registered for a total of seven
or more credits during a semester/quarter at any post-secondary (i.e. beyond
high school) institution in
______________________________________________________________________________________
1. Have you ever been subject to discipline,
suspension or probation at any institution of post secondary education
(beyond high school) for reasons not related to academic performance? □ Yes □ No
If yes, please attach
explanation.
2. Have you ever been convicted of a criminal
offense involving physical injury to persons or property or otherwise
institutionalized for conduct causing physical injury to persons or
property? □ Yes □ No
What do you consider to be
the most significant factor in your decision to apply to this institution?
______________________________________________________________________________________
I hereby certify that to the
best of my knowledge the foregoing information is true and complete without
evasion or misrepresentation. I understand that if it is later found
otherwise, it is sufficient cause for rejection or dismissal. If my
application for admission is approved, I agree to abide by the present and
future rules and regulations, both academic and nonacademic, and the
scholastic standards of the appropriate institution, its colleges, schools,
departments and institutes, including but not limited to those rules,
regulations and standards stated in both he undergraduate and graduate
catalogs. I further acknowledge that if I fail to adhere to these
regulations, or meet these requirements, my registration may be
canceled.
______________________________________________________________________________________
Applicant’s complete legal
signature
Date
Montana Institutions of higher education
using this application do not discriminate in admission, or the provision of
services, nor employment policies on the basis of race, gender, national
origin, martial status, creed, religion, color, age, or physical or mental
handicap.
□ Male □ Female
Until the time you were 18 years old, had either of your parents (or guardian(s), if applicable) with whom you resided COMPLETED a bachelor’s degree? □ Yes □ No □ Unsure
If you have a disability that
should be brought to the attention of the institution to which you are
seeking admittance, please submit a confidential request for accommodation
through the admissions office or the disability services office.
Documentation of disability may be required. No qualified individual with a
disability will be by reason of such disability be excluded from
participation in or be denied benefits for the services program or activities
of a public entity or be subject to discrimination by such entity. *
The U.S. Department of
Education, Office for Civil Rights, requires the institution to report
aggregate data about the ethnic background of students. The Montana
University System also requires the institution to report student’s ethnic
background data for tracking purpose in support of Board of Regents Policy on
Minority Achievement. The definitions of each category, except for American
Indian or Alaska Native, are based on those recommended by the federal
Interagency Committee on Education. The definition for American Indian was
adopted by the Board of Regents, June 21, 1989.
African American – A person
having origins in any of the black racial groups of
American Indian or Alaska
Native a- Indian ‘means’ any individual who 1) is a member of a tribe, band
or other organized group of Indians (as defined by the Indian, tribe, band or
other organized group), including those tribes bands or groups terminated
since 1940, and those recognized by the state in which they reside, or who is
descendant, in the first or second degree (first degree refers to parents and
second degree refers to child’s grandparents) of such a member, or 2) is
considered by the Secretary of the Interior to be an Indian for any purpose,
or 3) is an Eskimo Aleut or other Alaska Native.
Asian or Pacific Islander – A
person having origins in any of the original peoples of the Far East,
Southeast Asia or the
Caucasian/White Non-Hispanic
– A person having origins in any of the original peoples of Europe, North
Africa, the
Hispanic – A person of
Mexican, Puerto Rican, Cuban, Central or South American or other Spanish
culture or origin, regardless of race.
Please indicate if you are:
□ African American
□ American
Indian or
________________________________________________________
□ Asian or Pacific Islander, specify country of origin _______________________________
□ Caucasian/White, Non-Hispanic
□ Hispanic, specify country of origin ____________________________________________
If you are non-resident alien, please check here □.