WICHE/WRGP
APPLICATION FORM
Please answer all questions below and complete each section of the form. Any omission of required information may result in a denial
of your application to the WICHE/WRGP program at MSUB. Only students who have been admitted to MSUB in an approved program
and are residents of AK, AZ, CA, CO, HI, ID, MT, NV, NM, ND, OR, SD, UT, WA, WY and Pacific Island Territories may apply.
Approved Programs: MS Rehabilitation and Mental Health Counseling, Health Administration, Athletic Training, Public Relations,
MS Special Education Advanced Studies, ABA option.
PART I: Student Information
Name (Last, First, Middle)
Date of Birth (mm/dd/yyyy)
Degree and Program Admitted to:
PART II: Resident Information
What State do you claim residency
How Long have you lived in this state continuously as of today
Years Months
Are you registered to vote?
No Yes
Do you have a drivers license?
No Yes (if yes, please attach a copy)
Do you own or operate a vehicle?
No Yes
Did you file State or Federal Taxes in the last two years?
No Yes
PART III: Certification
I certify that the information on this application is complete and correct. I understand that any misrepresentation or falsification is sufficient cause for
denial or cancellation of any benefits derived from this application and could result in other disciplinary action. I further understand that all
documents submitted as part of this application become the property of Montana State University Billings and will not be returned to me, nor
duplicated for any reason. By submitting this application I am agreeing to the terms of this affidavit.
___________________________________________________________________________________ __________________________
Signature Date
PART IV: Submit application and supporting materials to the Office of Graduate Studies by the Deadlines
This form with all supporting documentation as well as all application materials must be submitted to the Office of Graduate Studies at MSUB by the
following deadlines: Fall semester (March 12) and Spring semester (November 1
st
). Applicants will be notified when the applications have been
evaluated.
M
ail: Office of Graduate Studies Phone: 406-657-2238
MSU Billings Email: gradstudies@msubillings.edu
1500 University Drive
Billings, MT 59101
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