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Montana Minds Scholarship Application

Last Name:

First Name:

MI:

Street:

City:

State:

Zip:

Phone:

E-Mail:

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Parents or Guardian's Name:

Street:

City:

State:

Zip:

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Are you a citizen of the United States?

If you are not a US citizen, what is your status?

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Name of High School:

Graduation Date:

Street:

City:

State:

Zip:

What is the name of your science teacher(s)?
Are you associated with either TRiO or GearUp?

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If you have taken either the ACT or SAT, please enter your scores.

My HS class size is:		ACT Score: Composite		Math:		English:
My HS class rank is:		SAT Score: Composite		Math:		Verbal:

My HS GPA is:

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Degree Sought (check appropriate box):

If you have any questions please contact:
Annette Kankelborg
Montana Tech
1300 West Park Street
Butte, MT 59701
406-496-4694
Akankelborg@mtech.edu

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