Please Print and Use Ink LEAVING ANY LINE ON THIS FORM BLANK COULD RESULT IN A DELAY
OBTAINING FINANCIAL AID.
STUDENT DATA FORM 2019-2020
STUDENT INFORMATION
Student Name: SSN/Banner I.D.#:
Address: Telephone Number:
City: State: Zip Code: Your Date of Birth: ______/ ______/ ______
I am seeking a degree at:
Online
MSU Northern Great Falls
Havre ____ ____
____
Enrollment Status: Fall Term 2019 Spring Term 2020 Will you attend Summer 2020?
12 or more credits 12 or more credits Yes
(Please indicate how many credits 9-11 credits 9-11 credits No
you plan on taking each semester) 6-8 credits 6-8 credits Half time will be assumed for all
1-5 credits 1-5 credits students for summer. You may
0 credits 0 credits change this after you register for
Summer classes in April 2020.
Legal Residence: Montana Military WUE Other state: ___________
Will you have earned a BACHELOR’S degree as of July 1, 2019? Yes No
RESOURCES
Expected resources, other than Federal financial aid, available to meet expenses during the term(s) financial aid is desired. If you do not know
the exact amount, but know that the agency will be covering tuition, fees and books, simply write in “TFB”. Note: All students must complete
this section with the best estimates possible. Married students should NOT include a spouse’s resources.
Resource Description Fall 2019 Spring 2020 Summer 2020
Vocational Rehabilitation Benefits $ $ $
Job Training Partnership Act (JTPA) or Project Challenge $ $ $
Military Tuition Assistance $ $ $
Scholarships (Source :_______________) $ $ $
Other Benefits (Source: __________________) $ $ $
Bureau of Indian Affairs Grant (Office: ___________) $ $ $
Did you receive a Native American Fee Waiver during 2018-19? Yes No
If you answered no and you are Native American, you may contact the Office of Financial aid for more information.
OTHER POST-SECONDARY ATTENDANCE
Have you attended or do you plan to attend any other post-secondary institution between July 1, 2019 and June 30, 2020? Yes No
If yes, list the institution name, city and state below. If no, write NONE below.
INSTITUTION
CITY, STATE
DATES OF ATTENDANCE
NO If so, when?YESHave you ever attended MSU Northern before? ___ ___ ______________
AUTHORIZATION
By signing this form, I certify that all the information reported to qualify for Federal and State student aid is complete and correct.
WARNING: If you purposely give false or misleading information on this form, you may be fined, be sent to jail, or both.
Student’s Signature Date
Return this form to: Financial Aid Office; MSU Northern; PO Box 7751; Havre, MT 59501
MSU Northern does not discriminate on the basis of race, color, national origin, age, sex, or disability.
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