2015 APPLICATION FORM
BRIDGING TRIBAL COLLEGE STUDENTS TO MONTANA STATE UNIVERSITY (BRIDGES)
MAY 29 – JULY 26, 2015
AMERICAN INDIAN RESEARCH OPPORTUNITIES (AIRO), PO BOX 173820
MONTANA STATE UNIVERSITY, BOZEMAN, MT 59717
Website: www.montana.edu/airo/bridges/
DEADLINE: FEBRUARY 16, 2015
Return application packet to your college’s Bridges Program Coordinator OR MSU-AIRO:
Bridges Program Coordinators:
Aaniiih Nakoda College: Jessica Stiffarm
Blackfeet College:
Steve Durtka
Chief Dull Knife College: Mary Noel
Ft Peck College:
Paula Firemoon
Little Big Horn College: Neva Tall Bear
Salish Kootenai College: Christina Rush
Stone Child College:
Larry Gomoll
MSU-AIRO:
PO Box 173820, 312 Roberts Hall
Montana State University-Bozeman
Bozeman, MT 59717-3925
amy.stix@coe.montana.edu
PH: (406) 994-5567; Fax: (406) 994-5559
NOTE: Applicants have the option to participate in the Bridges program at Salish Kootenai College
(SKC). Contact Program Coordinator Christina Rush for program dates/specifics. PH: (406) 275-4894
Email: christina_rush@skc.edu You may use this application to apply for the SKC program.
1.
Name:
(Last)
2.
(First)
Birthdate:___________________
3.
(Middle)
Banner ID: __________________________
(MSU-AIRO Office use only)
4.
6.
 Female
 Male
5. Tribal Affiliation:
Mailing Address:
(Street / PO Box)
7.
Contact Number (Include Area Code):
Please provide the most reliable phone number(s).
8.
(City, State)
Email address:
___________________
HOME
_____
Please provide the most reliable email.
9.
Tribal College:
(Zip)
10.
Major:
11.
Date of your expected graduation from Tribal College:
12.
Four-year university you plan to attend:
13.
Intended major at four-year university:
14.
Please list any coursework completed in math or science and grades received:
CELL
2015 APPLICATION FORM (Page 2)
BRIDGING TRIBAL COLLEGE STUDENTS TO MONTANA STATE UNIVERSITY-BOZEMAN
(BRIDGES)
MAY 29 – JULY 26, 2015
AMERICAN INDIAN RESEARCH OPPORTUNITIES (AIRO), PO BOX 173820
MONTANA STATE UNIVERSITY, BOZEMAN, MT 59717
15. Check the kind of housing you will need this summer:

Family housing (will bring spouse and/or children)

Dorms (will come alone)

Off campus (will take care of own housing off campus)
16. MSU REQUIRED SAFETY & SECURITY INFORMATION (All applicants must complete this section.)
1. Have you ever been convicted of a felony (please include instances of deferred sentencing)?
A felony in Montana State law is defined as a crime for which more than one year in prison may be
imposed.
2. Have you ever been subjected to court-ordered confinement for threatening or causing physical or
3. Have you ever been disciplined, suspended from, or placed on probation at any educational institution
Suspension is defined as a sanction imposed for disciplinary reasons that results in a student leaving
school for a specified time period. Dismissal from a college for disciplinary reasons is defined as
permanent separation from an institution of higher education on the basis of conduct or behavior.
4.
NOTE: Answering “Yes” to any of these questions will not automatically prevent admission, but you will
be asked by the university to provide additional information. This information will be reviewed by a
campus committee to ensure campus safety. Any falsification or omission of data may result in a denial of
admission or dismissal.
17. Research area of interest. Indicate your research interests for 2015 summer research project:

Agriculture

Cell Biology and Neuroscience

Engineering

Microbiology

Environmental Science

Immunology & Infectious

Natural Resources

Biology

Fish & Wildlife

Community Health

Biofilm Engineering

Psychology

Other:
Diseases
2015 APPLICATION FORM (Page 3)
BRIDGING TRIBAL COLLEGE STUDENTS TO MONTANA STATE UNIVERSITY-BOZEMAN
(BRIDGES)
MAY 29 – JULY 26, 2015
AMERICAN INDIAN RESEARCH OPPORTUNITIES (AIRO), PO BOX 173820
MONTANA STATE UNIVERSITY, BOZEMAN, MT 59717
18. Please tell us about yourself, including your career interests and goals, why you want to participate in
the Bridges program, and your interest in pursuing a career in science or engineering. Include any
academic and/or personal achievements and how these relate to your goals. (You may include additional
pages if necessary.)
2015 APPLICATION FORM (Page 4)
BRIDGING TRIBAL COLLEGE STUDENTS TO MONTANA STATE UNIVERSITY-BOZEMAN
(BRIDGES)
MAY 29 – JULY 26, 2015
AMERICAN INDIAN RESEARCH OPPORTUNITIES (AIRO), PO BOX 173820
MONTANA STATE UNIVERSITY, BOZEMAN, MT 59717
19.
Please meet with your tribal college’s Bridges Program Coordinator before submitting
your application to discuss the BRIDGES program and program expectations.
20.
Submit transcripts from all colleges you have attended.
21.
Submit two recommendations completed by: 1) your Bridges Program Coordinator and 2) an
instructor or college counselor (both recommendation forms are attached).
22.
Your application packet must be completed and submitted to MSU-AIRO office by FEBRUARY
16, 2015. All accepted applicants should plan to attend the Bridges Program Orientation at
MSU-Bozeman on Friday, May 29, 2015.
23.
Please call 406-994-5567 or send an email to Amy Stix amy.stix@coe.montana.edu if you
have any questions about the application process.
STUDENT WAIVER FORM FOR 2015 SUMMER
BRIDGING TRIBAL COLLEGE STUDENTS TO MONTANA STATE UNIVERSITY-BOZEMAN
(BRIDGES)
MAY 29 – JULY 26, 2015
AMERICAN INDIAN RESEARCH OPPORTUNITIES (AIRO), PO BOX 173820
MONTANA STATE UNIVERSITY, BOZEMAN, MT 59717
A. This section is to be filled out by student (print or type name):
NAME:
Under the provisions of the Family Educational Rights and Privacy Act, you may decide whether letters of reference
are to be held confidential or are to be available for your personal inspection. Please sign one of the following
statements:
□I DO NOT WAIVE my right of access to the form. It shall be made available to me for inspection upon written
request.
□I DO WAIVE my right of access to this form and grant permission for it to be held confidential.
___________________________________________
(Signature of applicant)
STUDENT RECOMMENDATION FORM FOR 2015 SUMMER
BRIDGING TRIBAL COLLEGE STUDENTS TO MONTANA STATE UNIVERSITY-BOZEMAN
(BRIDGES)
MAY 29 – JULY 26, 2015
AMERICAN INDIAN RESEARCH OPPORTUNITIES (AIRO), PO BOX 173820
MONTANA STATE UNIVERSITY, BOZEMAN, MT 59717
A. This section is be filled out by the tribal college instructor or counselor recommending the student.
A
Excellent
B
Good
C
Average
D
Poor
E
Don’t Know
A
B
C
D
E
1. INITIATIVE: Promptness, perseverance, self-discipline.
2. MOTIVATION: Seriousness, interest, commitment.
3. MATURITY: Common sense, sound judgment, decision-maker.
4. COMMUNICATION SKILLS: Oral expression, writing ability.
5. ABILITY TO LEARN: Potential for growth, self-development
6. SCIENCE BACKGROUND
7. MATH BACKGROUND
8. ATTENDANCE AND PUNCTUALITY: Observance of requirements.
9. FLEXIBILITY: Team-player, open-mindedness.
B. For Student Evaluators:
Please comment in the space below on the Bridges applicant’s: academic performance; experience
in STEM fields; career goals; motivation; and readiness to participate in an intensive science
research program. (You may include additional pages if necessary.)
Print Name of Tribal College Coordinator
Tribal College
STUDENT RECOMMENDATION FORM FOR 2015 SUMMER
BRIDGING TRIBAL COLLEGE STUDENTS TO MONTANA STATE UNIVERSITY-BOZEMAN
(BRIDGES)
MAY 29 – JULY 26, 2015
AMERICAN INDIAN RESEARCH OPPORTUNITIES (AIRO), PO BOX 173820
MONTANA STATE UNIVERSITY, BOZEMAN, MT 59717
A. This section is be filled out by the tribal college instructor or counselor recommending the student.
A
Excellent
B
Good
C
Average
D
Poor
E
Don’t Know
A
B
C
D
E
1. INITIATIVE: Promptness, perseverance, self-discipline.
2. MOTIVATION: Seriousness, interest, commitment.
3. MATURITY: Common sense, sound judgment, decision-maker.
4. COMMUNICATION SKILLS: Oral expression, writing ability.
5. ABILITY TO LEARN: Potential for growth, self-development
6. SCIENCE BACKGROUND
7. MATH BACKGROUND
8. ATTENDANCE AND PUNCTUALITY: Observance of requirements.
9. FLEXIBILITY: Team-player, open-mindedness.
B. For Student Evaluators:
Please comment in the space below on the Bridges applicant’s: academic performance; experience
in STEM fields; career goals; motivation; and readiness to participate in an intensive science
research program. (You may include additional pages if necessary.)
Print Name of Tribal College Coordinator
Tribal College