Application for Dual Enrollment Students

Personal Information

First Name

Preferred First Name (Optional)

Middle Name

Last Name

Mailing Address

Country

Street

City

Region

Postal Code

Place of Birth

Birthdate

Country of Citizenship

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

Social Security Number

Phone Number

Please enter your personal email address. Do not use your school email, as this will expire after your graduation.

Email Address

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian Email Address

Academic Information

Term of Enrollment

Name of High School (select from drop down)
If you are completing or have completed a high school equivalency program, such as the GED, HiSet, TASC, CHSPE, etc., please search for and select "High School Equivalency" in the Institution block.

Overall GPA:

Expected High School Graduation Date or Expected High School Equivalency Completion (Month & Year)

Safety and Security

A felony in Montana State law is defined as a crime for which more than one year in prison may be imposed.

Have you ever been convicted of a felony (please include instances of deferred sentencing)?

Provide information about the event.
This information will be reviewed by a campus committee to ensure campus safety. Any falsification or omission of data may result in a denial of admission or dismissal.

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

Provide information about the event.
This information will be reviewed by a campus committee to ensure campus safety. Any falsification or omission of data may result in a denial of admission or dismissal.

Have you been dismissed, suspended from, or placed on probation at any educational institution for
non-academic reasons?

Provide information about the event.
This information will be reviewed by a campus committee to ensure campus safety. Any falsification or omission of data may result in a denial of admission or dismissal.

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

Provide information about the event.
This information will be reviewed by a campus committee to ensure campus safety. Any falsification or omission of data may result in a denial of admission or dismissal.

Voluntary Statistical Information

Montana institutions of higher education using this application do not discriminate in admission or the provision of services nor employment policies on the basis of race, gender, national origin, marital status, creed, religion, color, age or physical or mental handicap. Providing the following information requested by this section is voluntary and the information provided is for statistical analysis only.

Legal Sex

Have either of your parent(s) or guardian(s) completed a bachelor’s degree?

Are you of Hispanic or Latino origin?

Yes

No

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

Signature

I hereby certify that to the best of my knowledge the foregoing information is true and complete without evasion or misrepresentation. I understand that if it is later found otherwise, it is sufficient cause for rejection or dismissal. If my application for admission is approved, I agree to abide by the present and future rules and regulations, both academic and nonacademic, and the scholastic standards of the appropriate institution, its colleges, schools, departments and institutes, including but not limited to those rules, regulations and standards stated in the catalog. I further acknowledge that if I fail to adhere to these regulations or meet these requirements, my registration may be canceled.

In place of your signature, please type your full legal name:

Date

Notice of Nondiscrimination: It is the policy of the Office of the Commissioner of Higher Education that there will be no discrimination or harassment on the grounds of race, color, sex, marital status, religion, national origin, age, sexual orientation, or disability in any educational programs, activities, or employment. Persons having questions about equal opportunity and nondiscrimination should contact the Office of the Commissioner of Higher Education MOA Coordinator at kwicks@montana.edu.