I COMPLETE. PRINT. SIGN I TRANSMITTAL OF UNDERGRADUATE APPLICATION MATERIALS

RETURN COMPLETED FORM, WITH CHECK OR MONEY ORDER, TO THE OFFICE OF THE REGISTRAR An $8/ee is due when 1hisform is s11bmi11ed. Ifyou have 11ever a//endeda parlicipa1i11g Monlana Universily Sys/em inslilulion. or //you ha1•e not attended one i11 the past {ivevears, you .may not use this form; you 11111s1 complele and submit an Application for Admission.

PROVIDE THE INFORMATION BELOW, PRINT THE FORM, SIGN IT,AND RETURN ITWITH THE $8 FEE TO THE OFFICE OF THE REGISTRAR. STUDENT NAME: LAST, FIRST MIDDLE (AND PREVIOUS NAMES): DATE OF BIRTH (MM/QQ/YYYY)' I STUDENT ID# OR SSN#:

EMAIL ADDRESS: PHONE NUMBER(S):

CURRENT MAILING ADDRESS: I CITY: STATE: I ZIPCODE: I

STATE IN WHICH YOU I How LONG HAVE YOU HAVE YOU BEEN OUTSIDE FOR MORE CLAIMRESIDENCY: I □ □ LIVED IN THIS STATE? THAN 30 DAYS IN THE LAST 1 2 MONTHS? YES No ARE YOU REGISTERED □ DO YOU FILE □ □ I YEAR OF MOST RECENT YES □ / TO VOTE IN MONTANA? No I MONTANATAXES? YES No MONTANA TAX FILING:

COUNTY IN WHICH YOU How LONG HAVE You How LONG HAVE You LIVED AT CLAIMRESIDENCY: □ I LIVED IN THIS COUNTY?□ I YOUR CURRENT ADDRESS? CITY COLLEGE AT MSU HELENA COLLEGE ·UM 0MSU·81LLINGS INSTITUTION □ □ □ DAWSON COMMUNITYCOLLEGE HIGHLANDSCOLLEGE· MT TECH MSU · BOZEMAN YOU ARE □ □ □ FLATHEAD VALLEY COMMUNITY COLLEGE MSU · NORTHERN TRANSFERRING □ □ □ TO (CHECK ONE): □ GALLATIN COLLEGE· MSU □ MISSOULA COLLEGE· UM □ GREAT FALLS COLLEGE MSU MONTANA TECH OF THE UM UM WESTERN

EXPECTED ENROLLMENT INTENDED DEGREE TERM (SPRING, SUMMER, FALU & YEAR: I &MAJOR: USE SACK OF TI-IIS FORM IF EXTRA WRmNG SPACE IS NEEDED FOR ANY ANSWERS BELOW

� HAVE YOU EVER BEEN CONVICTED OF A FELONY (INCLUDE INSTANCES OF DEFERRED SENTENCING)? IF YOU HAVE ANSWERED "YES" TO THIS QUESTION, PROVIDE INFORMATION FOR EVERY SUCH CONVICTION

� HAVE YOU EVER BEEN SUBJECTED TO COURT-ORDEREDCONFINEMENT FOR THREATENING OR CAUSING PHYSICAL OR EMOTIONAL INJURY TO PERSONS OR TO PROPERTY? IF YOU HAVE ANSWERED "YES" TO THIS QUESTION, PROVIDE INFORMATION FOR EVERY SUCH INCIDENT

P:, HAVE YOU EVER BEEN DISCIPLINED, SUSPENDED FROM, OR PLACED ON PROBATION AT ANY □ □ YES No EDUCATIONAL INSTITUTION FOR NON-ACADEMIC REASONS? IF YOU HAVE ANSWERED "YES" TO THIS QUESTION. PROVIDE INFORMATION FOR EVERY SUCH INCIDENT

J-0 HAVE YOU EVER f:!EEN REQUIRED TO REGISTER AS A SEXUAL OR VIOLENT OFFENDER? □ □ YES No IF YOU HAVE ANSWERED "YES" TO THIS QUESTION. PROVIDE INFORMATION FOR EVERY SUCH INCIDENT

LISTALL POST-SECONDARY INSTITUTIONS TTEN':>ED, SPf:CIFYJNG CA l:i D ATES OF ENROLLMENT. � _ _ ��-� �- !)_

NAME OF INSTITUTION LOCATION (CITY/STATE)

------�=E.J!_ACKOF THIS FQRM IF EXTRA SPACE IS Nggggg___ _

J understand that, by signing this transmittal request, I am authorizing the sending institution to include any information that is relevant to the admissions decision and is part of my admissions file in the Montana University System.

Applicant's Signature Date - FOR REFERENCE ONLY -

MILESCOMMUNITY COLLEGE CITY COLLEGE AT MSU ADMISSIONS OFFICE NEW STUDENT SERVICES 27 15 DICKINSON 3803 CENTRAL AVE. MILES CITY. MT 59301 BILLINGS, MT 591 02

MISSOULACOLLEGE DAWSON COMMUNITYCOLLEGE UNIVERSITYOF MONTANA ADMISSIONS OFFICE ENROLLMENT SERVICES & ADMISSIONS 300 COLLEGE DR. 909 SOUTH AVE. WEST GLENDIVE, MT 59330 MISSOULA, MT 59801-7 1 90

FLATHEADVALLEY MONTANATECH OF THE COMMUNITYCOLLEGE UNIVERSITY OF MONTANA ADMISSIONS OFFICE ADMISSIONS OFFICE 777 GRANDVIEW OR. 1 300 WEST PARK ST. KALISPELL. MT 59901 BUTTE, MT 59701

GALLATINCOLLEGE MSU • BIUJNGS MONTANASTATE UNIVERSITY ADMISSIONS OFFICE ADMISSIONS OFFICE 1500 UNIVERSITY DR. P.O. Box 172190 BILLINGS, MT 59101 BOZEMAN, MT 5971 7

MSU •BOZEMAN GREAT FALLS COLLEGE ADMISSIONS OFFICE P.O. Box 172190 ADMISSIONS OFFICE BOZEMAN, MT 5971 7 21 00 16TH AVE. SOUTH GREAT FALLS, MT 59405 MSU • NORTHERN ADMISSIONS OFFICE HELENACOLLEGE P.O. Box 7751 UNIVERSITYOF MONTANA HAVRE, MT 59501 ADMISSIONS OFFICE 1 1 15 NORTH ROBERTS UNIVERSITYOF MONTANA HELENA, MT 5960 1 ENROLLMENT SERVICES & ADMISSIONS LOMMASSON CENTER HIGHLANDSCOLLEGE MISSOULA, MT 59812 OF MONTANATECH ADMISSIONS OFFICE UNIVERSITY OF MONTANA·WESTERN 1 300 WEST PARK ST. ADMISSIONS OFFICE BUTTE, MT 59701 71 0 SOUTH ATLANTIC DILLON, MT 59725

OFFICE OFFICIAL ONLY: I HEREBY CERTIFY THIS RECORD IS COMPLETE. ALL DOCUMENTS

RELEVANT TO ADMISSION AT OUR INSTITUTION HAVE BEEN TRANSFERRED TO YOU IN FULL. MACRAO STAMP

SIGNATURE OF THE REGISTRAR GATE

INITIAL INITIAL THE STUDENT HAS COMPLETED: IHAVEN/PETSA IALCOHOLEDU