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Financial Aid Scholarship Form

Montana Tech of The University of Montana
North Campus Students Pursuing a Baccalaureate Degree
SCHOLARSHIP FORM
For Scholarship Committee & Departmental Consideration
Deadline: March 1, 2007

YOUR ELECTRONIC SIGNATURE IS REQUIRED ON THIS FORM.

Current Date:

First Name:

Last Name:

Student ID No:

TO BE ELIGIBLE FOR CONSIDERATION FOR SCHOLARSHIPS THE STUDENT MUST HAVE A DECLARED MAJOR COURSE OF STUDY ON HIS/HER PERMANENT RECORD IN THE REGISTRAR'S OFFICE. DECLARED MAJOR ON THIS FORM MUST MATCH YOUR DECLARED MAJOR IN THE BANNER SYSTEM.

Declared Major at Montana Tech:

Local Address Information:

Expected Date of Graduation from Montana Tech with a Bachelor's Degree (Month/Year):

Street:

City:

State:

Zip:

Local Phone Number:
E-Mail Address:

Summer Mailing Address Information:

Street:
City:

State:

Zip:

Contact Phone:

(If eligible, this is where your Scholarship Award Notification will be mailed.)

High School Graduated From:

Montana County:

Date of Birth:

State of Birth:

Are you a Montana Tech Collegiate Athlete? (Select the Sport(s).)

Football

Volleyball

Basketball

Golf

(You must be a member of the Montana Tech team in order to meet qualification for these scholarships. These are not for intramural or for leisure.)

Marital Status:	Single
	Married

Number of childen that you support:

Student Status:	Traditional (Started college within 3 years of high school graduation.)
	Non-Traditional

PLEASE REVIEW THE SCHOLARSHIP MINIMUM ELIGIBILITY REQUIREMENTS THAT ARE BELOW

Internships do not affect your eligibility for scholarships. Please complete the correct area regarding your internship.

Will you be on an internship that will require you to be registered less than full-time (12 credits)?

Fall	Yes	No
Spring	Yes	No

Name of Company:

City of Company:

Were you on an internship that required you to be registered less than full-time (12 credits)?

Fall	Yes	No
Spring	Yes	No

Name of Company:
City of Company: