2016 APPLICATION FORM

(1)

2016 APPLICATION FORM

BRIDGING TRIBAL COLLEGE STUDENTS TO MONTANA STATE UNIVERSITY (BRIDGES)

J

UNE

6 –

JULY

29,

2016

AMERICAN INDIAN RESEARCH OPPORTUNITIES (AIRO),POBOX 173820 MONTANA STATE UNIVERSITY,BOZEMAN,MT 59717

Website: www.montana.edu/airo/bridges/

DEADLINE: FEBRUARY 15, 2016

Return application packet to your college’s Bridges Program Coordinator

OR

MSU-AIRO:

Program Coordinators:

Aaniiih Nakoda College: Brian Grebliunas Blackfeet College: Jim Polk 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, Doug Crebs

MSU-AIRO:

PO Box 173820, 312 Roberts Hall Montana State University-Bozeman Bozeman, MT 59717-3925

[email protected] 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: [email protected] You may use this application to apply for the SKC program.

1. Name:

(Last) (First) (Middle)

2. Birthdate:___________________ 3. Banner ID: __________________________

(MSU-AIRO Office use only)

4. Female Male 5. Tribal Affiliation:

6. Mailing Address:

(Street / PO Box) (City, State) (Zip)

7. Contact Number (Include Area Code): ___________________ ______________________ Please provide reliable phone number(s). Home Cell

8. Email address: _____ ___________________________________

Please provide the most reliable email.

9. Tribal College: 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:

(2)

2016APPLICATION FORM (Page 2)

BRIDGING TRIBAL COLLEGE STUDENTS TO MONTANA STATE UNIVERSITY-BOZEMAN (BRIDGES)

J

UNE

6 –

JULY

29,

2016

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)?

 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 subjected to court-ordered confinement for threatening or causing physical or emotional injury to persons or property?  Yes  No

3. Have you ever been disciplined, suspended from, or placed on probation at any educational institution for nonacademic reasons?  Yes  No

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. Have you ever been required to register as a sexual or violent offender?  Yes  No

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 Engineering Environmental Science Natural Resources Biology Community Health Psychology

Cell Biology and Neuroscience Microbiology

Immunology & Infectious Diseases

Fish & Wildlife Biofilm Engineering Other:

(3)

2016 APPLICATION FORM (Page 3)

J

UNE

6 –

JULY

29,

2016

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

(4)

2016 APPLICATION FORM (Page 4)

J

UNE

6 –

JULY

29,

2016

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 15, 2016. All accepted applicants should plan to attend the Bridges Program Orientation at MSU-Bozeman on Thursday, June 2, 2016.

23. Please call 406-994-5567 or send an email to Julian Collins ([email protected]) if you have any questions about the application process.

(5)

STUDENT WAIVER FORM FOR 2016 SUMMER

J

UNE

6 –

JULY

29,

2016

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.

___________________________________________

(6)

STUDENT RECOMMENDATION FORM FOR 2016 SUMMER

BRIDGING TRIBAL COLLEGE STUDENTS TO MONTANA STATE UNIVERSITY-BOZEMAN

(BRIDGES)

J

UNE

6 –

JULY

29,

2016

A. This section is be filled out by the tribal college instructor or counselor recommending the student.

A B C D E

Excellent Good Average Poor 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.)

(7)

J

UNE

6 –

JULY

29,

2016

A. This section is be filled out by the tribal college instructor or counselor recommending the student.

A B C D E

Excellent Good Average Poor 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.)

(8)