MONTANA UNIVERSITY SYSTEM
OFFICE OF COMMISSIONER OF HIGHER EDUCATION
Student Financial Services
__________________________________________________________________
560 N. Park – PO Box 203201 – Helena, Montana 59620-3201
(406) 449-9168 - FAX (406) 449-9171 – Mtscholarships@montana.edu
Application for Montana University System
Surviving Dependents of Montana Firefighters/Peace Officers Waiver
QUALIFICATIONS: You may qualify for this waiver if you meet the following criteria:
• You are a resident of the State of Montana and will be attending a Montana University System campus.
• Your parent or spouse was a Montana Firefighter or Peace Officer that was killed in the course and scope of
employment.
LIMITATIONS:
• This Waiver does not waive any fees. Fees not covered by this waiver are your responsibility.
• This waiver cannot be used with other tuition waivers.
• This waiver can only be used towards undergraduate tuition.
• This waiver shall not apply to the extent that any such person is eligible for educational benefits from any governmental
or private benefit program that provides comparable benefits.
• To continue to receive this waiver, you must maintain Satisfactory Academic Progress (SAP) as defined by the campus.
Student Name: ________________________________________________________________________
First
Middle
Last
Social Security Number ___________________________ Date of Birth: __________________________
Address: ________________________________ City: _______________ State: _______ Zip: _________
Phone: _____________________ Email: ____________________________________________________
Campus choice: _________________ Semester you plan to begin using this waiver: ________________
Name of Fatally Injured Parent: __________________________________________________________
First Middle Last
Montana Firefighter or Peace Officer: _________________________ Date of Death: _______________
I certify that the information provided in this application is accurate and complete to the best of my knowledge.
________________________________________________ ______________________________
Signature Date
PLEASE SUBMIT THIS FORM, YOUR BIRTH CERTIFICATE, YOUR PARENT’S DEATH CERTIFICATE, PROOF OF PARENT’S LINE OF DUTY
DEATH DETERMINATION, PROOF OF YOUR PARENT’S MONTANA RESIDENCY DURING EMPLOYMENT, AND ANY ADDITIONAL
SUPPORTING DOCUMENTATION TO:
Montana University System, Scholarship Department, P.O. Box 203201, Helena, MT 59620
Once this form is approved/denied, you will receive notification from our office. If approved, you do not need to complete this
form again, as long as you remain continuously enrolled at this campus and you continue to meet the requirements listed above.
