Registrar & Records
1500 University Drive
Billings, MT 59101-0245
1-406-657-2158
registrar@msubillings.edu
Former Student Application
Term of Intended Return to MSU Billings:
Personal Information
Fall Spring Summer
Year:
Student ID (or last 4 of SSN)
Last Name First Name
Middle Name
Previous Name(s)
Mailing Address
City
State Zip
Permanent Address
City State Zip
Email Address Cell Phone Home Phone
Birth Date
Gender
Ethnicity information is for statistical analysis only. It is not used in the admission process and will have no bearing on your admission status.
Indicate your ethnic identity:
Hispanic / Latino
Not Hispanic or Latino
If not Hispanic or Latino, indicate which of one or more racial categories should be used to classify you:
American Indian or Alaska Native
Asian
African American
Native Hawaiian or Other Pacific Islander
White
Specify primary tribal affiliation or reservation:
Specify country of origin:
Specify country of origin:
Educational Information
Do you currently hold a bachelors or a masters degree?
Proposed major upon returning to MSU Billings:
Previous dates of attendance at MSU Billings/EMC/BVTC:
Name of College or University City State Attendance Dates (to - from) Degrees/Credits Earned
Safety and Security
Have you ever been convicted of a felony (please include instances of deferred sentencing)?
Have you ever been subjected to court-ordered confinement for threatening or causing physical or emotional injury to persons or property?
Have you ever been disciplined, suspended from, or placed on probation at any educational institution for non-academic reasons?
Have you ever been required to register as a sexual or violent offender?
List all post-secondary institutions attended, including MSU Institutions. Contact all institutions and request an official transcript be sent to the MSU Billings Admissions and Records Office.
Yes No
Yes No
Yes No
Yes No
Yes No
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 nonacademic, 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 registration may be canceled.
Male
Female
Are you a US citizen?
Residency Classification
If not US, are you a permanent resident alien of the US?
Have you lived in Montana for the past 12 continuous months?
Are you a resident of Montana?
Do you file Montana taxes?
If you own a vehicle, is it registered in Montana?
Do you have a MT Drivers License or State ID?
Yes No
Yes No
Yes No
NoYes
Yes No
Yes NoYes No
Year of most recent Montana tax filing:
If you are not a resident of Montana, in which state do you claim residency?
Internal Use Only
Date of Issue:
Degree:
Signature Date
Processed by: Date:
P
click to sign
signature
click to edit
![]()
