Other Information cccccccccccccccccccccccccccccccccccccc ccccccccccccccccccccccccccccc
Parent(s)/Legal Guardian(s) Name_______________________________________________________________________________
Address ___________________________________________________________________________________________________
City _________________________________________ Province_____________ Postal Code______________________________
On a separate piece of paper, please provide the following information for each dependent accompanying you to the U.S.: family name, first name,
date of birth, country of birth, gender and relationship (spouse or child).
If you are currently in the U.S., what is your immigration status and visa expiration date? _________________________________
Required Safety and Security Information ccccccccccccccccccccccccccccccccccccccccccccc
Have you ever been convicted of a felony (include instances of deferred sentencing)? Yes No
Have you ever been subjected to court-ordered confinement for threatening or Yes No
causing physical or emotional injury to persons or property?
Have you ever been disciplined, suspended from, or placed on probation at any Yes No
post-secondary educational institution for non-academic reasons?
Have you ever been required to register as a sexual or violent offender? Yes No
An affirmative response to any of these questions will not automatically prevent admission, but you will be asked by the university 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.
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I hereby certify that to the best of my knowledge the foregoing information is true and complete without evasion or misrepresentation. I agree to
abide by the present and future rules and regulations, both academic and non-academic, and the scholastic standards of MSU-Northern, its colleges,
departments and institutes including but not limited to those rules, regulations and standards stated in the undergraduate/graduate catalog. I further
acknowledge that if I fail to adhere to these regulations or meet these requirements, my registration may be canceled.
If I am admitted to MSU-Northern, I agree to pay all tuition, fees, fines and debts to the university that may be incurred by me. I understand that
MSU-Northern will take action against me to collect any unpaid debts, including withholding of registration, transcripts and assignment of the debt
for collection, and I will be responsible to pay any costs incurred to collect the debt.
Applicant complete legal signature: ___________________________________________________________________________________________
signature date
Application Requirements dddddddddddddddddddddddddddddddddddddddddddddddd
The following materials should be submitted to Montana State University-Northern, Admissions Office, PO Box 7751,
Havre, MT 59501 USA
Applicants must submit a complete International Undergraduate Application for Admission.
A non-refundable application fee of $30 USD that can be paid with a credit card or international money order.
A statement of financial support that verifies that funds will be available to cover estimated costs of attendance (in U.S.
dollars) for one academic year. This reference letter or bank statement should be from a bank or financial institution
regarding funds of a financial sponsor, the student, or the parent/legal guardian.
Official academic records for any secondary or post-secondary institutions attended, with a posted date of completion
should be sent directly from the institution to MSU-Northern.
An exact English translation must accompany all academic records not written in English.
Students living in countries in which English is not the primary language must show English proficiency by receiving a
minimum score of 475 Pbt (153 Cbt or 53 iBT) on the Test of English as a Foreign Language (TOEFL) or completion of an
English as a Second Language (ESL) Program, including ESL Language Centers, for undergraduate admission.
Physician validated immunization record of mumps, measles (rubeola), and rubella (MMR) immunity. Diphtheria-
Tetanus (DT or Td), and skin testing for Tuberculosis that was completed within one year of the planned attendance date.
This evidence must be presented before a student is permitted to register for classes.
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