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SQ 3 Fillable Web

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U.S.A. forms for Great Falls College Montana State University

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changing lives - achieving dreams
Our Mission is to foster the success of our students and their communities
through innovative, flexible learning opportunities for people of all ages,
backgrounds, and aspirations resulting in self-fulfillment and
competitiveness in an increasingly global society.
GREAT FALLS COLLEGE MSU
OFFICE OF ADMISSIONS
2100 16th Avenue South, Great Falls, MT 59405
[406] 771.4300 or [800] 446.2698 fax: [406] 771.4329
www.gfcmsu.edu
Dear Prospective Student,
Thank you for your interest in Great Falls College MSU. It has come to the attention of the Admissions Office that you
have marked or will have to mark affirmative to one of the safety and security questions on the Admissions Application.
The safety and security of our building, faculty, staff and students is foremost in our minds. In order for our office to
further evaluate and process your application you must complete the following steps and return any requested
documentation.
Complete the Safety and Security Questionnaire that is with this letter
SIGN and DATE the Consent to Release Information which is located in the Safety and Security Questionnaire.
This release will pertain to non-academic information, by educational institutions and other, relating to any
discipline, suspension or dismissal from the educational institution.
Provide a letter from the dean of Students office at the college(s) where the dismissal/suspension occurred
documenting the status of the dismissal/suspension.
A personal interview after above items have been provided. *Please note, this will not be scheduled until the
above has been completed
Our Admissions Committee typically meets the first and third weeks of the month. We will review the information that
you provide at this time. If the committee feels additional information is required prior to processing your will be
informed in writing.
*Please note: this process can take 4-6 weeks so timely completion of your requirements is essential. If you have
questions or concerns about this process please contact Brittany Budeski at 406-771-4309 or
brittany.budeski@gfcmsu.edu. Please keep this letter for your records.
Sincerely,
Brittany Budeski
Director of Admissions and New Student Services
Enc: SQ3
changing lives - achieving dreams
Our Mission is to foster the success of our students and their communities
through innovative, flexible learning opportunities for people of all ages,
backgrounds, and aspirations resulting in self-fulfillment and
competitiveness in an increasingly global society.
GREAT FALLS COLLEGE MSU
OFFICE OF ADMISSIONS
2100 16th Avenue South, Great Falls, MT 59405
[406] 771.4300 or [800] 446.2698 fax: [406] 771.4329
www.gfcmsu.edu
Safety and Security Questionnaire - Checklist
On your application for admission to the Great Falls College MSU you answered in the affirmative to the
“Safety and Security” question – Have you ever been disciplined, suspended from, or placed on probation
at any educational institution for non-academic, disciplinary reasons?
The safety and security of our building, faculty, staff and students is foremost in our minds. In order to evaluate
your application for admission or readmission, please complete the following questionnaire for every felony
conviction.
The following lists the required information and/or items necessary to complete the process. Please initial
next to each item when you have completed it. After all required items are returned, please sign at the
bottom of the page and return to the Admissions Office. All items turned into the Admission Committee as
part of the Safety and Security process become property of Great Falls and will not be returned to the student.
______ A completed Safety and Security Questionnaire
______ A signed and dated Consent to Release of Information located on the Safety and Security Questionnaire
regarding non-academic information, by educational institutions and others, relating to any
discipline, suspension or dismissal from an educational institution
______ Provide a letter from the Dean of Students office at the college(s) where the dismissal/suspension
occurred documenting the status of the dismissal/suspension
______ A personal interview after above items have been provided
______________________________________________ __________________
Student Signature Date
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Safety and Security Questionnaire
On your application for admission to the Great Falls College MSU, you answered in the affirmative to the
Safety and Security question: Have you ever been disciplined, suspended from, or placed on probation at
any educational institution for non-academic, disciplinary reasons? Suspension is defined as a sanction
imposed for disciplinary reasons that results in a student leaving school for a fixed time period, less than
permanently. Dismissal from an education institution for disciplinary reasons is defined as a permanent
separation from an institution on the basis of conduct or behavior.
In order for us to evaluate your application for admission further, please complete the following questionnaire
for each felony conviction. Please note that failure to submit detailed information will delay your
admission process.
1. Nature of the conduct for which you were disciplined, suspended or dismissed:
2. Institution(s) at which disciplinary action was imposed: (identify specific institution name, location, &
phone number)
3. Specific date(s) of violation(s):
4. Regulation or policy violated:
5. Circumstance(s) surrounding the violation(s) for which you were disciplined, suspended or dismissed:
6. Details of discipline imposed (suspension? probation? dismissal?):
7. Period of time for which dismissal, suspension or probation imposed?
8. If suspended or dismissed, have you applied for readmission? Yes___ No___
Were you readmitted? Yes___ No___
Were there any conditions imposed upon your readmission? Yes___ No___
If yes, what were the conditions?
6. Please provide the name(s), location(s), and phone number(s) of contact person(s) at the institution(s):
PLEASE ALLOW 4-6 WEEKS FOR PROCESSING
RELEASE OF INFORMATION:
I hereby consent to the release of any and all non-academic information, by educational institutions and others,
relating to any discipline, suspension or dismissal from a post-secondary institution. I give this consent to
enable Great Falls College MSU to fully evaluate my application for admission and acknowledge that the
information provided will be so used.
Applicant’s Signature: __________________________________________________
Date of Authorization: __________________ Expiration Date: _______________
With my signature below, I certify that the information I have provided in this questionnaire is complete and
true. I understand that falsification or omission of information requested may result in denial of admission.
________________________________________ ________________________________________
Applicant’s Signature Print Name
_____________________________
Date
**If the Admissions Committee process is not completed, and you have not been admitted to Great Falls
College MSU within one year of application, all records regarding this matter will be destroyed.
Please return to: Great Falls College MSU
Admissions Office Attn: Brittany Budeski
2100 16
th
Avenue South
Great Falls, Montana 59405
(406) 771-4420 or (800) 446-2698
Please be advised that if you apply for admission to another Montana University System institution, a copy of this
form may be forwarded, upon administrative request, to the appropriate officials at that institution.
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Completed 18 November 2019

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