Zip Code:
Have you been outside Montana for more
than 30 days in the last 12 months?
How long have you
lived in this state?
State in which you
claim residency:
Use back of this form if extra space is needed
Have you ever been convicted of a felony (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 to 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?
Student Name: Last, First Middle (and Previous Names):
Current Mailing Address:
Campus you are transferring to:
Montana State University Transfer Application
for Billings, Bozeman, Great Falls, & Northern
Provide the information below, print the form, sign it, and mail or fax the completed, signed form to the Admissions
Office of the school you are transferring to. Additional information may be requested by the Admissions Office.
If you have never attended MSU Billings, Bozeman, Great Falls, or Northern, you may not use this form.
I understand that by signing this transfer application, I am authorizing the release of any MSU information relevant to the
admission decision. I also understand that the school I am transferring to may require additional information.
Applicant's Signature Date
MSU-Billings MSU-Bozeman MSU-Great Falls MSU-Northern
Campus you are leaving:
MSU-Billings MSU-Great Falls MSU-NorthernMSU-Bozeman
February 2011 - MSU Bozeman - Office of the Registrar
Name of Institution Location (City/State) Attended From (mm/yyyy) Attended To (mm/yyyy)
Year of most recent
Montana tax filing:
Student ID# or SSN#:Date of Birth (mm/dd/yyyy):
Phone Number(s):
State: City:
Email Address:
If you have answered "Yes" to this question, provide information for EVERY such conviction
If you have answered "Yes" to this question, provide information for EVERY such incident
If you have answered "Yes" to this question, provide information for EVERY such incident
If you have answered "Yes" to this question, provide information for EVERY such incident
Do you file
Montana Taxes?
Are you registered
to vote in Montana?
Use back of this form if extra writing space is needed for any answers below
Spring FallSummer
Expected Enrollment Term:
No
Yes
No
Yes
NoYes
No
Yes
Current Degree
& Major
Intended Degree
& Major
List all post-secondary institutions attended, including all MSU institutions.
Expected Enrollment Year:
Yes No
Yes No Yes No
An affirmative response to any of these questions will not automatically prevent admission, but you will be asked by the college
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.
Complete, Print, SIGN, and Mail
