CANNOT PROCEED WITHOUT THIS STEP

Create User ID: (First 2 letters of first name and Date Of Birth)
Example: RA010185

User ID:

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Term Interested In Fall 2009

Full First Name   MI
Preferred Name Last Name

Date

Age Height Weight Birthdate

ADDRESS INFORMATION

Street
City     State Zip
Home Phone    Cell Phone

Best Day To Call: Any Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday Best Time to Call: Anytime Morning Afternoon Evening

Email

Spouse's Name

Mother'sName Occupation
Employer          Email          
Mother's Address

Father's Name Occupation
Employer          Email          
Father's Address

Living With: Both Parents Mother Father Other Define Other

Parent/Guardian or Permanent Address:
Street
City     State Zip

SCHOOL INFORMATION

GPA Class Rank Class Size          Transfer GPA Transfer Credits
ACT English                     Date Taken:
ACT Math                         Date Taken:
ACT Science                   Date Taken:
ACT Writing                     Date Taken:
ACT Composite Score   Date Taken:
SAT Verbal                      Date Taken:
SAT Math                         Date Taken:
SAT Writing                      Date Taken:
SAT Compostie Score   Date Taken:


Anticipated College Major: BISI Biological Sciences BIT Business Information Technology BUS Business CH Chemistry CS Computer Science EN Environmental Engineering GE General Engineering GE General Engineering/Civil Engineering GE General Engineering/Mechanical Engineering GE General Engineering/Welding Engineering GS General Science GNST General Studies GL Geological Engineering GP Geophysical Engineering HCI Health Care Informatics NT Network Technology LS Liberal Studies MA Mathematics MTME Metallurgical Engineering MN Mining Engineering MTRN Nusring OSH Occupational Safety & Health Pre-Med/Pre-Vet PT Petroleum Engineering PTC Professional & Technical Communication SE Software Engineering UE Undecided Engineering UD Undeclared

High School Name Year of Graduation
Street             
City                  State Zip

Junior College
Street              
City                   State Zip JC Graduation Date
****Note: Transfers from 4-year institutions must obtain a release before Montana Tech coaches can contact you.

Guidance Counselor
School Phone       
Coach's Name     
Office Number      
Home Phone        

FOOTBALL STATS

Jersey Number      
Offensive Position 
Defensive Position
40 yard time           
Specialty Areas      None Kick Punt Long Snap
Athletic Injuries:
Football Honors (Academic/Athletic)
Other Varsity Sports:

Must Submit From Confirmation Page

Any Questions Contact:
Coach Green 406-496-4292
Coach Doug Schleeman 406-496-4768
Montana Tech Football
1300 West Park Street
Butte, MT 59701

To Apply For Admission