Barton County Community College, Great Bend, KS: Online Forms

Admissions Application Form

Personal Information

Social Security Number*:

(Your social security number will not be used as assigned college ID number.)

*In order to protect your privacy, Social Security Number is not required to cmplete the application for admission. Your SSN is used as a matching identifier to avoid student duplication and match with submitted Federal Financial Aid. If you choose to not enter your SSN on this form and prefer to give your SSN to an Admissions Representative, please contact the Barton Admissions Offive (620) 792-9286 or 800-722-6842.

Do you plan to enroll in?

Year

Complete Legal Name:

Last:

First:

Middle:

Previous or Maiden Name:

Address:

City:

State:

Zip:

Phone Number:

E-Mail address:

Sex: Male Female

Date of Birth(Month/Day/Year):

Ethnicity (Data used for reporting purposes only)

Please select the primary category of ethnicity that best describes you

Non-resident alien	Asian
American Indian or Alaska Native	White
Native Hawaiian or Other Pacific Islander	Hispanics of any race
Black or African American	Two or more races
Race and Ethnicity unknown

Do either of your biological or adoptive parents have a bachelor's degree? Yes No

Are you a member of the military family? Dependant Active Duty Other No

Residency Status:
Your residency status will not affect your admission to the College. It is used only to determine your tuition based on state and federal laws.

Are you a U.S. citizen? Yes No

If no, please provide Alien Registration Number

Citizenship is used to determine tuition rate. Students must provide alien resident card or refer to " Non U.S. Citizens" procedures in the Kansas residency statement and request an affidavit if applicable.

If yes, are you a Kansas resident? Yes No

Date Kansas Residency Began (Month/ Day/ Year):

Legal County of Residence:

Date County Residency Began (Month/ Day/ Year):

Please read the Kansas Residency Statement and Requirements on the bottom of this page.

HIGH SCHOOL INFORMATION:

NOTE: All degree seeking students must have official post-graduation transcripts (high school, home school, or proof of GED) sent by the granting institution directly to Barton. Home school credit evaluations may be submitted in lieu of a transcript or diploma from the school administrator.

High School Graduate GED Graduate Home School Graduate

High School/ Home School/ GED Center Name:

City: State: Zip:

High School/ Home School Graduation Date (Month/ Year):

GED Certificate (Month/ Year of Completion):

BARTON ACADEMIC SCHOLARSHIP AWARD APPLICATION

Application deadline is March 15 for the following academic year.

Academic scholarships will be awarded to graduates of Kansas high schools or other Kansas residents their GED from a center in Kansas based on the highest of the following criteria: Grade Point Average, ACT composite score, or GED score.

Cumulative High School GPA: based on 4.0 scale or GED Score (if applicable):

ACT Scores: Composite: English: Math: Reading: Science:

Student Athletes: Jayhawk Conference rules state that students receiving an athletic books and tuition scholarship must meet a 3.5 GPA criteria upon high school graduation and are eligible for only one academic scholarship in the amount of no more than $500 a semester or $1000 a year.

PREVIOUS COLLEGE(S):
NOTE: All degree seeking students must have official post-graduation transcripts (high school, home school, or proof of GED) from each institution attended sent by the granting institution directly to Barton.

List in order all colleges attended.

Name	City	State	Dates Attended	Degree/Hrs. Earned

Have you ever been dismissed from any College/University? Yes No

If yes:
Institution Name: Date of Dismissal:

Reason for Dismissal:

Enrollment Information:

1. Student Type: Check one only

First Time Freshman Continuing/ Former Barton Student Transfer to Barton

Non-H. S./ Non-GED Student

2. Are you seeking a certificate and/ or degree from Barton County Community College?
Certificate Degree Both Neither

Major AREA of study:

I certify that to the best of my knowledge the information on this form is true and complete without evasion or misrepresentation. I understand that submission of false information and/or failure to submit supporting documents is grounds for denial of admission, re-enrollment or immediate suspension if enrolled. If accepted as a student at Barton County Community College, I agree to abide by the rules and regulations of the college regarding conduct, financial, and other obligations.
By checking this box you have created an electronic signature as legally binding as your handwritten signature. *

*Required

KANSAS RESIDENCY STATEMENT AND REQUIREMENTS

All applicants indicate your residency status on the application.
■ For the purpose of being assessed college tuition, Kansas residents are persons, who, if adults, have resided, or if minors (under 18) whose parents have resided in Kansas for six months immediately preceding the first day of classes.
■ In some cases, residency status is subject to interpretation by Barton. Such persons as financially independent students whose parents reside in another state, Non-residents who marry residents, military personnel and their dependents stationed in Kansas, and students acquiring an abode, whether by purchase, renting or otherwise and intending to live in it permanently or indefinitely, should consult Enrollment Services if in doubt about their residency status.
■ It is the student’s responsibility to enroll under the proper residency classification. If there is any question concerning residency status, it is the student's responsibility to raise the question in the Enrollment Services before paying fees.

Non U.S. Citizens
Certain undocumented immigrants and others may be eligible for resident tuition. This applies to any student who:
1. Has attended an accredited Kansas high school for three or more years and
2. Either graduated from an accredited Kansas high school or has earned a GED issued in Kansas and
3.
a. in the case of a person without lawful immigration status; has signed and filed an affidavit with the institution stating that the person or the person's parents have filed an application to legalize such person's immigration status, or will file such an application as soon as such person is eligible to do so or
b. in the case of a person with a legal nonpermanent immigration status, has filed with the postsecondary education institution an affidavit stating that such person has filed an application to begin the process for U.S. citizenship or will file such application as soon as such person is eligible to do so.
Students who meet eligibility requirements should request an affidavit from the Admissions Office or the Office of Enrollment Services.