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) 496-4683.

General Information:
Last Name: *
First Name: *
Middle Name *
Preferred name
Montana Tech Student ID *
Social Security Number *
Address: *
Address 2:
City: *
State: *
Zip Code: *
Home Phone *
Cell Phone Number:
Email Address: *
Date of Birth: *
United States Resident
Gender *
Preferred Pronoun *
Veteran Status *
Marital Status *

Racial Category

Please select the category/categories that best represents your racial identification and mark all others with a no.
Race, American Indian or Alaskan Native *
Race, Asian *
Race, Black or African American *
Race, Hawaiian or other Native to Pacific Island *
Race, Hispanic *
Race, White *

Academic Info:
Describe your primary reason for applying: *
When did you first enroll at Montana Tech?
Declared Science, Technology, Engineering, or Mathematics (STEM) major.
Did you apply for and receive Financial Aid this year?
Current Grade Level: *
Are you a full or part time student? *
Current GPA: *
How's your academic standing? *
SSS services you might take advantage of? (Check all that apply)
Academic Procedures
Personal development workshops
Career advising
Academic skills
Financial Aid advising
Personal counseling
Workshops

Why might you utilize TRIO SSS services?(check all that apply)

Out of academics 5 or more years
Failing grades (H.S. or College)
Low ACT/SAT scores
Uncertain of academic preparedness
Need for academic support
Uncertain of career goals
Uncertain of educational goals
Limited English proficiency
Diagnostic test score
High School Equivalency (GED)
Other Reason

Do you have a documented disability? (Physical/Learning/Emotional/Mental) *
Are you currently registered with Tech's Disability Services for students? *

Eligibility for Program Services
TRIO is a support program funded by the Federal government to ensure students who are the first in their families to attend college, have the resources and care needed to graduate.

We ask for access to your academic history and records in order to customize services to meet your needs, and federal reporting requirements.

Eligibility Information:
Parents Educational Level: *
How many people in your household at home? *
Family Income Range: *
Most Recent IRS 1040

Sign and Submit:
Applicant Signature *
Please select a signature verification type.

Terms of Submission:
I certify that the information on this application is accurate and complete to the best of my knowledge. 

 I hereby authorize the Student Support Services program to obtain any information from my educational records (e.g., transcripts, entrance test scores, grades, instructor contacts, etc.) and to perform staffing activities that may be pertinent to my participation in this project. 

 I also agree that, if I am selected to participate in the TRIO SSS project, I will work with my staff advisor to develop and implement an individual Education Assessment Plan.