Transmittal of Undergraduate Application Materials
Return completed form, with check or money order, to the Office of the Registrar
An $8 fee is due when this form is submitted. If you have never attended a participating Montana University System institution, or if you have not
attended one Uin the past five yearsU, you Umay not use this formU; you must complete and submit an Application for Admission.
Provide the information below, print the form, sign it, and return it with the $8 fee to the Office of The Registrar.
Student Name: Last, First Middle (and Previous Names): Date of Birth (mm/dd/yyyy): Student ID# or SSN#:
(s):
Current Mailing Address:
City:
State: Zip Code:
State in which you
claim residency:
How long have you
lived in this state?
Have you been outside Montana for more
than 30 days in the last 12 months?
Yes No
to vote in Montana?
Yes No
Montana Taxes?
Yes No
Year of most recent
Montana tax filing:
County in which you
claim residency:
How long have you
lived in this County?
How long have you lived at
your current address?
City College at MSU
Dawson Community College
Flathead Valley Community College
Gallatin College - MSU
Great Falls College MSU
Institution
You are
Transferring
to (check one):
Expected Enrollment
Term (Spring, Summer, Fall) & Year:
Intended Degree
& Major:
Use back of this form if extra writing space is needed for any answers below
Have you ever been convicted of a felony (include instances of deferred sentencing)?
Yes No
If you have answered "Yes" to this question, provide information for EVERY such conviction
Have you ever been subjected to court-ordered confinement for threatening or
causing physical or emotional injury to persons or to property?
If you have answered "Yes" to this question, provide information for EVERY such incident
Yes No
Have you ever been disciplined, suspended from, or placed on probation at any
educational institution for non-academic reasons?
If you have answered "Yes" to this question, provide information for EVERY such incident
Yes No
Have you ever been required to register as a sexual or violent offender?
If you have answered "Yes" to this question, provide information for EVERY such incident
Yes No
List all post-secondary institutions attended, specifying campus and dates of enrollment.
Name of Institution Location (City/State) Attended From (mm/yyyy) Attended To (mm/yyyy)
U Use back of this form if extra space is needed
I understand that, by signing this transmittal request, I am authorizing the sending institution to include any information that is relevant to the admissions
decision and is part of my admissions file in the Montana University System.
Applicant's Signature Date
Complete, Print, Sign
Helena College -UM
Highlands College - MT Tech
Miles
Community College
Missoula College - UM
Montana Tech of the UM
MSU - Billings
MSU - Bozeman
MSU - Northern
University of Montana
UM Western
