Application for Readmission
Please mail or Fax:
Office of Admissions PO Box 819 Browning, Mt 59417 Fax 406-338-3776 Phone 406-338-5441
Name______________________________________________________ Student ID # ___________________________
List any other name under which your records might appear________________________________________________
Mailing Address: __________________________ Permanent Address: _________________________________________
Telephone Number (___) _____________________________Cell Number (___) _________________________________
Date of Birth _______________________________________ Gender: Male Female
Are you a citizen of the United States? Yes No if no, what is your immigration status? ______________________
High school graduation place and date: __________________________________________________________________
HiSET/GED date of completion: _____________Testing center name: _____________City and State: __________________
List all colleges/universities attended since last enrolled at Blackfeet Community College
(Name) (Location) (Dates) (Degrees Earned)
Term of Enrollment: Fall 20_____ Spring 20 _____ Summer 20 ____
Please indicate your educational goal:
Associate’s degree or Certificate (Indicate field of study) _______________________________ (See declaration of major form)
Non-degree seeking (not pursuing a degree, certificate or financial aid at this institution)
For personal/professional development
For transfer to another institution
For teacher certification
2 + 2 Consortium Student List degree seeking ______________________ List home institution ____________________
Associate of Arts Degree
AA – Addiction Studies
AA – Behavioral Health
AA – Psychology
AA – Social Work
AA – Liberal Studies
AA – Piikani Studies and Language
Other: ____________ Catalog year ___________
Associate of Science Degree
AS – Accounting
AS – Business Management
AS – Elementary Education
AS – Criminal Justice – Legal Studies
AS – Environmental Science
AS – Health Science
AS – Pre-Engineering
AS – Hydrology Technician – Pending Funding
AS – Nursing
Other: ____________ Catalog year ___________
Associate of Applied Science Degree
AAS – Early Childhood Education
Other: ____________ Catalog year ___________
One-Year Certificates/Endorsements
Behavioral Health Aide – 1-year certificate
Blackfeet Legal Studies – 1-year certificate
Early Childhood Development – 1-year certificate
Record Information Management – 1-year certificate
Agri-Business – 1-year certificate
Hydrology Technician Aide – Pending Funding
GIS/GPS – Pending Funding
Other: Catalog year
Please select your major:
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Application for Readmission
Disability Information
If you have a disability and may require accommodations, please submit a confidential written request for disabilities
accommodations. Written documentation of the disability is required. All documentation will be confidential and used only in
accordance with federal regulations; Section 504 of the Rehabilitation Act and Americans with Disabilities Act.
BCC Disabilities coordinator
Beaver Painted Lodge – Student Success Center
P.O. Box 819
Browning, Mt 59417
(406) 338-5421 Extension 2233
Safety and Security – All applicants must answer the following questions.
Have you ever been convicted of a felony (please include instances of deferred sentencing)? Yes No
A felony in Montana State Law is defined as a crime for which more than one year in prison may be imposed.
Have you been subjected to court-ordered confinement for threatening or causing physically or emotional injury to
persons or property? Yes No
Have you ever been disciplined, suspended from, or placed on probation at any educational institution for non-academic
reasons that results in a student leaving school for a fixed time, period, less than permanently. Dismissal from a college
for disciplinary reasons is defined as a permanent separation from an institution of higher education on the basis of
conduct or behavior. Yes No
Have you ever been required to register as a sexual or violent offender? Yes No
If you answered “yes” to any of the above questions, please provide and explanation with this application. Failure to do
so will delay the processing of your application.
An affirmative response to any of these questions will not automatically prevent admission, but you will be asked by BCC
to provide additional information. This information will be reviewed by a campus committee to ensure campus safety.
Any falsification or omission of data may result in a denial of admission or dismissal.
I hereby certify, to the best of my knowledge, the information on this application for readmission is true and complete,
without evasion or misrepresentation. I understand that, if it is later found otherwise, it is sufficient cause for rejection or
Date of application ________________________ Applicant’s Complete Legal Signature_______________________
If my application of readmission is approved, I agree to abide by the present and future rules and regulations both
academic and non-academic, 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 the undergraduate and
graduate catalogs, I further acknowledge that, if I fail to adhere to these regulations or meet these requirements, my
registrations may be cancelled.
Date of application ________________________ Applicant’s Complete Legal Signature_______________________
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