Financial Award Application
Mr.
Ms. ID #:
(Last or Family Name) (First) (Middle) (Optional)
Proposed Field of Study: Expected Entry Semester:
Mailing Address: Permanent Address:
Home Telephone #: Work Telephone #:
Single Married # of Children: Other Dependents:
Please select all types of Financial Awards you are applying for:
Graduate Teaching Assistantship (GTA) Tuition Waiver Graduate Research Assistantship (GRA)
Please answer the following questions:
1. What three disciplines do you feel most qualified to teach? (i.e., Chemistry, Physics, etc.)
Discipline
(i.e., Chemistry, Physics, etc.)
Highest Course Completed
(i.e., Chemistry 305)
2. Will you or do you expect to receive financial assistance from any source during the academic year (this
includes parents, self, spouse, or relatives)? No Yes
If Yes, please indicate amount and source:
3. Do you or your spouse expect to be employed in any capacity during the academic year? No Yes
If Yes, please give details:
4. Will you be under the financial sponsorship of any individual or organization? No Yes
If Yes, please give details:
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 from Montana Tech.
Signature: Date:
1300 West Park
Butte, MT 59701-8997 USA
Tel: 406.496.4304
Fax: 406.496.4710
E-Mail: gradschool@mtech.edu
http://www.mtech.edu/gradsch
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