**APPLY ONLINE**

Montana Minds NSF Scholarship Application
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Last Name:
First Name:
Middle Initial:
Address:
City:
State:
Zip Code:
Phone: E-Mail Address:
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Parents or Guardian's Name:
Address:
City:
State:
Zip Code:
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Are you a citizen of the United States? Yes *** No
If you are not a citizen of the United States, what is your status?
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Name of High School:
Graduation Date:
High School Address:
City:
State:
Zip Code:
What is the name of your science teacher(s):

Are you associated with GearUp or either Talent Search or Upward Bound (TRiO programs)?
Check the appropriate box(es)? * ** GearUp *** Talent Search *** Upward Bound

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If you have taken either the ACT or SAT, please enter your scores.
HS Class Size:  
ACT Scores:
Composite:
  
Math:
  
English:
  
HS Rank:  
SAT Scores:
Total:
  
Math:
  
Verbal:
  
HS GPA  
Counselors should have the class size and rank information.
 
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Degree Sought (check appropriate box):
Biology * Chemistry * Computer Science * Mathematics * Software Engineering

Mail this application to:
Annette Kankelborg
Montana Tech; 1300 West Park Street; Butte, MT; 59701
Phone: 406-496-4694 ***** E-Mail: Akankelborg@mtech.edu

or complete the application on-line at http://www.mtech.edu/scholarships/MontanaMindsApps.htm