Fillable Aaniiih Nakoda College ADMISSION APPLICATION (Aaniiih Nakoda College)

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Aaniiih Nakoda College ADMISSION APPLICATION (Aaniiih Nakoda College)

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Aaniiih Nakoda College
ADMISSION APPLICATION
A one-time non-refundable application fee of $10 must accompany this
application.
Full Time Enrollment: ______ Part Time Enrollment_____ Non Declared:_________
Fall Semester 20_______ Spring Semester 20_____ Summer Session 20_____
Please indicate your educational goal: ______________________________________________
Full Legal Name:_____________________________________________________Maiden___________________
Other Names Used:____________________________________________________________________________
Mailing Address:______________________________________________________________________________
Address City State Zip County
Permanent Address:____________________________________________________________________________
Address City State Zip County
Social Security Number:____________-___________-_____________
We ask you to voluntarily provide this number which permits the college 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.
Telephone Number:________________________________Email Address:_______________________________
Birthdate:_____________________________ Male Female Are you a Veteran? Yes No
Country of Citizenship___________________ If not U.S.A., are you a permanent resident alien: Yes No
If you are or will be a high school graduate, please indicate:
High School Name
Graduation Date
High School City/State
If you have or will receive you HiSet/GED, please indicate:
Test Date
Test Site
City/Sate
Did you attend Head Start?
Age
Site
City/Sate
Personal Information
Education
Please list any college or university you previously attended and provide an official transcript for each, whether or
not credit was earned.
Were you ever suspended or dismissed for academic reasons? Yes No
If yes, Please explain:__________________________________________________________________________
School Name
School Address
Attendance Dates
Degree/Credits Earned
What is your ethnicity: Native American Indian African American Hispanic/Latino
Caucasian/White Asian Other
Are you an enrolled member of federally recognized tribe? Yes No Enrollment #____________________
Are you a descendent of an enrolled member of federally recognized tribe? Yes No
Please list parent’s tribal affiliation and enrollment number:___________________________________________
Name and Location of Tribe:____________________________________________________________________
Do you speak your tribal language: Yes No Fluently Conversational Basic
Disability Information: If you have a disability (learning/physical) for which accommodations may be necessary, please submit a
confidential written request for disability accommodations to Dean of Student Affairs, P.O. Box 159, Harlem, Montana 59526. Disability
accommodation information will be confidential used only in accordance with federal regulations issued pursuant to Section 504 of the
Rehabilitation Act of 1973 and American with Disabilities Act.
Family Education Rights and Privacy Act (FERPA): All official student academic records are housed in the Registrar/Admission
Office. An institution may disclose “directory-type” information to third parties without consent from the student according to FBC
policy. The following directory-type information may be given to any inquirer without written authorization from the student: Name,
address, major, number of credits currently taking, diplomas or certificates awarded, honors, and date of completion. A student who
wants any or all of this information to remain confidential must inform the Registrar in writing. Any student requesting a release of
information covered under FERPA rules and regulations must complete a written request.
Are you required to register as a sexual or violent offender? Yes No
Applicant’s Complete Legal Signature Date
Official Use Only
Date Application Received:
Application Fee Received:
Assigned Advisor
Initials
College Information
Ethnicity Information
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Aaniiih Nakoda College ADMISSION APPLICATION (Aaniiih Nakoda College)

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Completed 3 February 2021

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