Montana State University-Great Falls College of Technology
Application for Dual Enrollment or Dual Credit Students
2100 16th Avenue South, Great Falls, MT 59405
(406) 771-4300 ∙ Toll Free (800) 446-2698 ∙ Fax (406) 771-4329 ∙ Web www.msugf.edu
*A $30.00 nonrefundable fee must accompany this application (waived for Aug. 2010 MTDA pilot)
Enrollment Information
PLEASE TYPE OR PRINT
 Fall term 20_____
Desired term of enrollment:
 Spring term 20_____
 Summer term 20_____
Were you previously enrolled at MSU GF – COT? If so, what term? ________________________________________________________
Personal Information
Full Legal Name: Last: _________________________ First: _______________________ Middle:__________________
Previous Name(s) __________________________________________________________________________________
Social Security Number________-_____-________ or Student ID Number______________________________
We ask that you voluntarily provide this number, which permits the school to distinguish between individuals of the same or similar names. This is
especially important should you request a transcript at a later date or wish to be considered for financial aid.
Mailing address: Street: ______________________________________________________________________________
City:________________ State: _______ Zip:______________
Home Phone: _____________________
(If Montana, indicate county) _____________________________
Cell Phone: _______________________
Permanent address: Street:______________________________________________________________________________
City:________________ State: _______ Zip:______________
Home Phone: ____________________
Cell Phone: ______________________
E-mail address __________________________________________
Birthdate ___________/____________/_____________
Birthplace ________________________________________________
Country of Citizenship*(Example: USA)__________________________________________________________________
If not U.S., are you a permanent resident alien of the U.S.?
 Yes
 No
Academic History
Complete name of high school ________________________________________ City:________________________ State:__________
Expected graduation date:
______/______/_______
Residency Information
Are you claiming in-state tuition classification as a Montana resident?
Yes
No
If No, of what state are you a resident? _________
If yes, please answer the follow questions regarding your residency status:
You
1.
Dates of continuous physical residence in Montana.
NA
____/____ to ___/____
mo/yr
mo/yr
Parents/Guardian
NA
___/____ to ___/____

2. I am or will be a graduate of a Montana high school after attending that school for my entire senior year, and I have or will
be registering at a Unit of the Montana State University System within two fall terms of my high school graduation.
Yes
No
3. I am a dependent child of an individual who is a member of the armed forces of the United States assigned to active duty in
Montana.
Yes
No
Statistical Information
Providing this information is voluntary.
Montana State University - Great Falls College of Technology is committed to the provision of equal opportunity for education,
employment, and participation in all College programs and activities without regard to race, color, gender, marital status, disability,
disadvantage, religion, political affiliation and/or national origin. Providing the following information requested by this section is voluntary
and the information provided will not be used in any admissions decisions.
1. Gender
 Male
 Female
2. Have either of your parents or guardian(s) COMPLETED a bachelor’s degree?
 Yes  No  Unsure
3. Indicate your ethnic identity by checking the appropriate boxes. This information is for statistical analysis only; it is not used in the
admission process and will have no bearing on your admission status.
a. Indicate your ethnic identity by checking the appropriate boxes:



Nonresident Alien
Race and Ethnicity Unknown
Hispanic (any race)
b. If not Hispanic or Latino, indicate which one or more racial categories should be used to classify you:






American Indian or Alaska Native Specify primary tribal affiliation and reservation ________________________________
Asian
Specify country of origin ____________________________________________________
Black or African American
Native Hawaiian /Pacific Islander
Specify country of origin _____________________________________________________
White or Caucasian
Two or more races
Students with Disabilities
If you have a disability that may require accommodation in any aspect of your education, you may contact Disability Services at any point in
the admissions process. Applicants who need an alternative format of this application may request it from Disability Services. All
information regarding disabilities will remain confidential and will not be used as a factor in granting or denying admission. For more
information about Disability Services, visit http://www.msugf.edu/studentlife/DisabilityServices/index.htm.
Safety and Security
This section must be completed.
1. Have you ever been convicted of a felony?
Yes
No
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 otherwise institutionalized for threatening or causing physical or emotional injury to persons or property?
Yes
No
Suspension is defined as a sanction imposed for disciplinary reasons that results in a student leaving school for a fixed time period, less than permanently. 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.
3. Have you been dismissed and/or suspended from a college for disciplinary reasons?
Yes
No
An affirmative response to any of these questions will not automatically prevent admission, but you will be asked by the college 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.
Signature
I hereby certify that to the best of my knowledge the foregoing information is true and complete without evasion or misrepresentation. I understand that if it is later
found otherwise, it is sufficient cause for rejection or dismissal. If my application for admission is approved, I agree to abide by the present and future rules and
regulations, both academic and nonacademic, and the scholastic standards of the appropriate institution, its colleges, schools, departments and institutes, including but
not limited to those rules, regulations and standards stated in the catalog. I further acknowledge that if I fail to adhere to these regulations or meet these
requirements, my registration may be canceled.
Students in Dual Enrollment or Dual Credit courses will follow the College’s official academic year calendar, catalog, policies and procedures.
X
Applicant’s complete legal signature
Date
MSU-Great Falls College of Technology
Dual Enrollment or Dual Credit Request for Enrollment Form
An application for admission must be on file to be eligible to register for classes. This form must be submitted
each term and must be completed by the student and signed by the high school counselor or principal.
NAME: __________________________________________________________________________________
(Last)
(First)
(Middle)
SOCIAL SECURITY NUMBER: ___________________ DATE OF BIRTH: ________________________
HOME ADDRESS: _______________________________________________
Zip: ___________________
HIGH SCHOOL: _____________________________________________________________
SEMESTER:
______ Fall
______Spring
______Summer
YEAR: ____________
Expected high school graduation date: _______________
COURSE SELECTION:
Online?




CRN No.
Yes
No
Yes
No
Yes
No
Subject
Course No
Section
Instructor
Adding or dropping courses may affect your bill with the college.
Students in Dual Enrollment or Dual Credit courses will follow the College’s official academic year calendar, catalog,
policies and procedures.
There is no guarantee that these courses will be taught or that spaces will be available for high school students.
Students will need to provide placement test scores if requesting enrollment in English, math or biology courses.
(Student Signature)
(Date)
APPROVAL:
(Parent/Guardian signature if student is under 18 years of age)
(Date)
(Montana Digital Academy Representative signature)
(Date)
** Authorization for Release of Information (opposite side) must be filled out to complete registration
MSU-Great Falls College of Technology
Dual Enrollment or Dual Credit Student Authorization for Release of Information
I do hereby authorize MSU – Great Falls College of Technology to discuss and/or release the following information:
Student Name: _________________________________ I.D. #: _________________________
Date of Birth: _________________ High School: _____________________________________
Please complete the box below by checking the appropriate boxes. Please also complete the date of
authorization and expiration date (if any).
RELEASE
Grades:
to Parents
Yes: 
to MTDA
Yes: 
to High School/District
Yes: 
Bills:
Yes: 
Yes: 
Yes: 
Attendance:
Yes: 
Yes: 
Yes: 
Enrollment:
Yes: 
Yes: 
Yes: 
Date of Authorization: ____________________ Expiration Date: __________________
Additional information to be released: ____________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
(Student Signature)
(Date)
(Parent/Guardian signature if student is under 18 years of age)
(Date)