Chancellor’s Excellence Awards Application
BIOGRAPHICAL INFORMATION:
Name (Last, First, MI) __________________________________________________________________________________________________________________
MSUB Student ID# _________________________________________________ Phone number_______________________________________________________
Permanent Address ___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
E-mail Address
Parents’ / Guardians’ Name(s)
Parents’ / Guardians’ Permanent Home Address: Street/Box City
County State Zip
ACADEMIC INFORMATION:
High School(s) attended (name, address, and year(s) attended): _______________________________________________________________________________
_____________________________________________________________________________________________________________________________________
Date of high school graduation________________Cumulative high school GPA on a 4.0 scale ____________High school class rank ______ in a class of _______
ACT (English)___________ (Math)___________ (Reading)___________ (Science Reason)___________ Composite____________
SAT (English)___________ (Math)___________ (Writing)___________ Total___________
List Advanced Placement courses successfully completed or currently in progress _________________________________________________________________
_____________________________________________________________________________________________________________________________________
National Merit Seminalist? ___Yes ___No
Other High School Academic Awards/Honors: _______________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
Intended Field(s) of Study _______________________________________________________________________________________________________________
ADDITIONAL INFORMATION:
U.S. Citizen? ____Yes ___No State of legal residence_____________________________ If Montana resident, what county? ____________________________
Gender ____Male ____Female Marital status_________________________________ Have you ever been married?____________________________
Dependents? ____Yes ____No If yes, list ages________________________________________________________________________________
Employer______________________________________________________________________________________ Hours worked per week___________________
REQUIRED MATERIALS:
In order to be considered for a Chancellor’s Excellence Award, you must apply for admission at Montana State University Billings. We recommend applying for
admission at least two weeks before the January 15 scholarship deadline to allow adequate processing time for your admission application. In addition, and in
order to be considered, you must include all the below-listed materials with this application postmarked no later than January 15.
1. A letter addressing each of the following areas:
a) Please list and indicate year(s) of involvement in school/community service; and your leadership role in school/community clubs, organizations,
committees, departments, work experience and/or other groups or activities.
b) Briey state how you have beneted from your involvement in these activities.
c) Please explain why you are interested in attending MSU Billings and completing a four-year degree at MSU Billings.
d) Please describe how you plan to become actively involved at MSU Billings.
e) Please list any additional information (personal, nancial, etc.) you would like the scholarship committee to consider.
2. A transcript of your high school record including your cumulative GPA, rank in class and college test results. If ACT or SAT scores are not included on
transcript, the candidate must arrange to have such results (either ACT or SAT) forwarded by a responsible ofcial to the Chancellor’s Excellence Awards
Committee at MSU Billings Foundation no later than January 15.
3. A list of your senior year high school courses in which you are currently enrolled and that you plan to enroll in during the year. (If currently enrolled in
high school.)
4. Three letters of recommendation from non-relatives who can attest to your academic achievements and potential, leadership skills, and community
service experience (e.g. high school teacher, school administrator, school counselor, employer, community person, etc.). Each letter should include the
person’s name, address, occupation, title, and his/her relationship or afliation to you. Please ask your references to address the following: 1) How long and
in what capacity have you known the applicant? What is your position? 2) Describe the applicant’s motivation and potential for academic success. Please be
specic. 4) Describe the applicant’s leadership skills and/or involvement in school/community service. 3) Describe the applicant’s distinctive qualities and
characteristics, you have personally observed, that make the applicant particularly well qualied to receive a Chancellor’s Excellence Award.
5. An essay of no more than two pages (double-spaced) on your future goals and aspirations and how Montana State University Billings will play a role
in attaining those goals. Describe the academic, personal and other educational goals you seek to accomplish while attending Montana State University
Billings (be as specic as possible).
DECLARATION OF INTENT:
I wish to be considered for the Chancellor’s Excellence Award. I have made separate application for admission to Montana State University Billings and have
read and agree to all conditions stipulated for candidates for Chancellor’s Excellence Awards, including my intent to enroll in a Montana State University Billings
bachelor’s degree program and complete a four-year undergraduate degree conferred by Montana State University-Billings. I certify that the above information
is true and correct to the best of my knowledge and permit Montana State University Billings to release relevant public information to scholarship donors and/
or the news media.
_____________________________________________________________________________________________________________________________________
Signature of applicant Date