Online Application

denotes required fields.

Contact Information

Last Name

First Name

Birthdate

Phone Number

Address 1

Address 2

City

State

Zip /Postal Code

Country

If not a U.S. citizen, are you a permanent resident of the U.S.?

Yes

Are you your own guardian?

Yes

Parent/Guardian Contact Information

Last Name

First Name

Relationship to Student

Phone Number

Address 1

Address 2

City

State

Zip /Postal Code

Country

Education History (include high school(s) and colleges or universities)

School 1

Name of School

City, State

Date started

Graduation Date or Reason for Leaving

School 2

Name of School

City, State

Date started

Graduation Date or Reason for Leaving

School 3

Name of School

City, State

Date started

Graduation Date or Reason for Leaving

Diploma or Certificate

Name of diploma or certificate received

Date receieved

Support Services

Student receives support or services from: Check all that apply and indicate if you are on a waiting list.

If you selected "other" or are on a waiting list, please specify:

Did you participate in general education classes during high school?

Yes

If yes, please list inclusive classes:

Please describe your academic strengths.

Please describe your academic challenges.

How do you think you learn best?

Please describe any accommodations used in school.

Are there any assistive tools that you use regularly?

Yes

If yes, please explain:

Work History

Job 1

Name of Employer or Organization

Job Title

Volunteer or Paid

Volunteer

Paid

Job Duties

Start date

End date

Job 2

Name of Employer or Organization

Job Title

Volunteer or Paid

Volunteer

Paid

Job Duties

Start date

End date

Job 3

Name of Employer or Organization

Job Title

Volunteer or Paid

Volunteer

Paid

Job Duties

Start date

End date

Job 4

Name of Employer or Organization

Job Title

Volunteer or Paid

Volunteer

Paid

Job Duties

Start date

End date

Job 5

Name of Employer or Organization

Job Title

Volunteer or Paid

Volunteer

Paid

Job Duties

Start date

End date

Work Information

Have you received job coaching during your work experience?

Yes

Have you ever been fired from a job?

Yes

If yes, please explain:

Have you ever quit a job?

Yes

If yes, please explain:

Have you ever had difficulty getting along with a supervisor, co-worker or a customer on a job?

Yes

If yes, how did you handle that?

Please list how you are currently occupied (school, work, volunteer, support services activites, etc.):

Activity 1

Activity

Time Day of week, Hours.

Provider (if applicable)

Activity 2

Activity

TimeDay of week, Hours.

Provider (if applicable)

Activity 3

Activity

TimeDay of week, Hours.

Provider (if applicable)

Activity 4

Activity

TimeDay of week, Hours.

Provider (if applicable)

Activity 5

Activity

TimeDay of week, Hours.

Provider (if applicable)

Student Questionaire

Why do you want to be a MSU LIFE Scholar?

What classes are you interested in taking?

What social activities, clubs or events are of interest to you?

What are your future career goals after college? What type of job would you like?

How do you want to be employed in the community upon completion of your college experience?

Full-time

Part-time (16+ hrs./week)

What are your future living goals? Do you want to live on your own, with a roommate or your family?

Please use this space to share anything else about yourself that you'd like us to know.

Student Skills Assessment

Applicant's Name

Date

Please use the following scale to document your skill level in each area. The document may be completed with input from parents or guardians.

1 = I need total support.
2 = I need some support.
3 = I am independent.

MSU Safety and Security Information

Have you ever been convicted of a felony?

Yes

Please include instance of deferred sentencing.

If yes, please explain:

Have you ever been subjected to court-ordered confinement for threatening or causing physical or emotional injury to persons or property?

Yes

If yes, please explain:

Have you ever been disciplined by, suspended from, or placed on probation at any educational institution for nonacademic reasons?

Yes

If yes, please explain:

Have you ever been required to register as a sexual or violent offender?

Yes

If yes, please explain:

If you answered yes to any of these questions, you may be asked by MSU to provide additional information, which will be reviewed to ensure campus safety.

Voluntary Information

Gender

Female

Male

Self Identify

Have either of your parents or guardian(s) completed a bachelor's degree?

Yes

If so, was this a degree from Montana State University in Bozeman?

Yes

Please indicate if you are:

If other, please specify:

Signature (required)

This application for admission is not legally binding.

I certify that the information submitted in this application is true and compelte. If I enroll at Montana State University, I agree to pay to the University all tuition, fees, fines, and debts that I may incur by the assigned due dates. If I fail to make acceptable payment arrangements to bring my account current, Montana State University will take action against me to collect any unpaid debts including withholding of registration and transcript(s) and assignment of the debt for collection. I understand that I will then be responsible for paying the principal plus collection agency fees of a maximum of 33% of my delinquent account balance, including costs, expenses and reasonable attoryney's fees necessary for the collection of my delinquent account. Collection accounts are reported to one or more of the national credit bureaus.

Date

Signature

I have read the application information, agree to the above terms and conditions, and verify that all above information is correct and current.

I Agree

I Disagree

Legal Guardian or Conservator (if applicable):

Name of person assisting student with the application:

Relationship to student:

Date:

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LIFE Scholars

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