Thank you for your interest in our Student Support Services program!  Please complete this application as thoroughly as possible.  You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.  If you have any questions, please call our office at 406-791-5213.

General Information:
Last Name: *
First Name: *
Middle Name:
Date of Birth: *
Address: *
Address 2:
City: *
State: *
Zip Code: *
Home Phone
Cell Phone Number:
Email Address:

Ethnicity

Academic Info:
Select the statement that best applies. *
Current Grade Level: *
How many classes are you taking?
Current GPA:
How's your academic standing?

Family Information:
Parents Educational Level:
How many people in your household at home?
Family Income Range:

Do you have a documented Disability?

Applicant Signature *
Please select a signature verification type.
Terms of Submission:
By submitting this application, you acknowledge that all of the above information is correct and accurate to the best of your understanding.
Sign and Submit: