Statistical Information
Providing the following information requested by this section is voluntary and the information provided is for statistical analysis only.
Gender: ❍ Male ❍ Female
Age Range: ❍ 18 - 25 ❍ 26 - 36 ❍ 37 - 50 ❍ 51+
Marital Status: ❍ Married ❍ Single ❍Divorced ❍Widowed
Are you a Veteran: ❍ Yes❍ No If yes, what branch did you serve? __________________ Dates of service _________________
Number of Dependents: ______________ Religious preference: ________________
Has either of your parents(s) or guardian(s) completed a bachelor’s degree? ❍ Yes ❍ No ❍ Unsure
Disclosure Information
In accordance with the Family Educational Rights & Privacy Act of 1974, the Registrar informs students that the college may disclose
information from the educational record of a student who is or has been in attendance at Blackfeet Community College. The following
information is considered by the college to be public in nature: name, address, telephone number, year in school, major, scholarship(s)
awarded, degree(s) conferred, Honor(s) granted, dates attended
Students have the right to refuse to permit the college from disclosing the above information. This is an “all or nothing” policy. The student
may not select certain information or certain circumstances for non-disclosure. The student’s name will not appear on any lists released to
third parties, including honor rolls and will NOT receive emergency messages. Students must fill out a “FERPA Privacy Rights Request
Form” (from the Registrar’s Office) to refuse to permit the college to disclose the above information.
Media Release
I, the undersigned, consent and grant to Blackfeet Community College, and its designees all rights to use my name, portrait, picture,
photograph or likeness of same at its discretion for internal & external presentations and community development-related external
promotions for BCC without further notice to me. I hereby waive any inspection or approval of any internal presentations and/or external
community development related promotions in which my name/photos appears; I release BCC from any liability for any claim of visual
alteration, optical illusion or faulty mechanical reproduction. I hereby waive all legal claims to compensation or receipt of consideration
from the rights granted by this consent and further acknowledgement that this consent is valid. I warrant and represent that I am over the age
of eighteen and have given this consent voluntarily.
___________________________________________ _______________________________________
Applicants complete legal signature Date
Signature Verification
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 non-academic, and the scholastic standards stated in the
catalog. I further acknowledge that if I fail to adhere to these regulations or meet these requirement, my registration may be canceled.
If I am admitted to BCC, I agree to pay all tuition, fees, fines and debts to the college that may be incurred by me, I understand that BCC
will take action against me to collect any unpaid debts, including withholding of registration, grades, transcripts, degree(s) and an
assignment of the debt for collection, and I will be responsible to pay any costs incurred to collect the debt.
___________________________________________________________ ___________________________________________________________________________________
Applicants complete legal signature Date
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