Admissions Application Form
Date of Birth(MM/DD/YYYY):
Ethnicity (Data used for reporting purposes only)
Are you Hispanic or Latino?
What is your race? (If applicable, check all categories of race that best describe you)
Do either of your biological or adoptive parents have a bachelor's degree?
Are you affiliated with the military?
If Other, Please Specify:
Would you like to be contacted by the Disability Services Office?
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?
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.
Are you a Kansas resident?
Date Kansas Residency Began (MM/ DD/ YYYY):
Legal County of Residence:
Date County Residency Began (MM/DD/YYYY):
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) on file. Home school credit evaluations may be submitted in lieu of a transcript or diploma from the school administrator.
High School Graduate
Home School Graduate
High School/ Home School/ GED Center Name:
High School/ Home School Graduation Date (Month/ Year):
GED Certificate (Month/ Year of Completion):
BARTON ACADEMIC SCHOLARSHIP AWARD APPLICATION
Application deadline is May 1st and December 1st for the following academic semester.
Academic scholarships will be awarded to first time freshman that are 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):
Student Athletes: Jayhawk Conference rules state that students receiving an athletic books and tuition scholarship, you must meet a 3.5 GPA criteria upon high school graduation to accept a Barton Academic Scholarship in addition to the Barton Athletic Scholarship.
Do you intend to apply for Federal Financial Aid at Barton Community College?
For Federal Aid (Grants and Student Loans), apply at this link. You must be seeking a degree or certificate at Barton to receive Federal Aid.
*Information will be used for both Admission and Scholarship purposes.
NOTE: All degree seeking students must have official post-graduation transcripts (high school, home school, or proof of GED) from each institution attended on file.
List in order all colleges attended.
The following best describes me: (Mark all that apply.)
Never attended college before (NEW)
Attended college, but not Barton (Transfer)
Previously attended Barton (including classes at my high school) (CONTINUING/FORMER)
Please select one of the following to describe your reason for coming to Barton Community College:
Obtain a degree/certificate at Barton for the job market
Obtain a degree/certificate at Barton, and then transfer to a 4-year college or university.
Transfer to a 4-year college or university before completing a degree or certificate at Barton.
Train for a new career by taking only selected courses.
Upgrade skills for current job by taking only selected courses.
Obtain knowledge for personal interest.
Taking classes to meet requirements while currently attending a college/university elsewhere (Transient)
Reason not listed.
DEGREE, CERTIFICATE OR PROGRAM INTEREST:
Please select your major code
Non-Degree Seeking: 9200
Adv Emergency Med Tech AEMT : 5114
Agricultural Economics: 0110
Agricultural Education: 0111
Agriculture Business Management: 0106
Agriculture Communications: 0109
Agriculture Transfer Option: 0100
Animal Science: 0211
Anthropology Cultural Studies: 4504
Architectural Engineering: 1403
Art Education: 1309
Athletic Training: 2610
Automotive Technology (AAS): 4706
Automotive Technology (Certificate): 4706
Beef Cattle Production (Certificate) : 0102
Business Leadership & Mang (AAS): 5217
Business Leadership & Mang (Certificate): 5217
Business Admin Technology: 5205
Certified Medication Aide : 5126
Computer Aided Drafting (Certificate) : 4608
Computer Information Systems: 5213
Computer Science: 1101
Corrections (AAS): 4306
Corrections (Certificate): 4306
Criminal Justice (AAS): 4301
Criminal Justice (Certificate): 4301
Crop Protection (AAS): 0104
Crop Protection (Certificate): 0104
Dental Hygiene: 2611
Dietary Management (AS): 2006
Dietary Manager (Certificate) : 2004
Early Childhood: 2003
Early Childhood Education: 1304
Elementary Education: 1301
Emergency Medical Responder : 5115
Emergency Mgmt/Homeland Security (AAS): 4508
Emergency Mgmt/Homeland Security (Certificate): 4508
EMS Instructor Coordinator : 5129
EMS Training Officer I : 5127
EMS Training Officer II : 5128
EMT : 5017
Engineering Technology: 1402
Environ Compliance Concent : 1506
Exercise Science: 2618
Food Science: 0212
Gas Measurement: 4607
General Studies: 2401
Golf Course Mgmnt: 0213
Graphic Design: 5003
Hazardous Materials Management: 1505
Healthcare Documentation & Transcription Specialist (Certificate) : 5223
Health Information Mgmnt: 2612
Horticulture/Turf Mgmnt: 0216
Infant/Toddler Education & Care (Certificate) : 2008
Liberal Studies: 2402
Manufacturing Skills: 1506
Math Education: 1307
Medical Admin Technology: 5209
Medical Assistant: 5222
Medical Coding (Certificate): 5227
Medical Coding (AAS): 5227
Medical Laboratory Technician: 5110
Military Leadership (Certificate) : 2905
Military Logistics (Certificate) : 2903
Military Dangerous Materials Handling (Certificate) : 2904
Military Studies Emphasis: 4507
Milling Science: 0214
Modern Languages: 1601
Mortuary Science: 2605
Music Education: 1305
Natural Gas Trans/Distrib Tech (AAS): 4606
Natural Gas Trans/Distrib Tech (Certificate) : 4606
Networking Specialist (Certificate): 5215
Nursing – PN (Certificate) : 5116
Nutrition and Health : 2009
Occupational Therapy: 2623
Optometry : 2606
Park Mgmt and Conservation: 0215
Pharmacy Technician: 5228
Phlebotomy Training : 5111
Physical Education: 1303
Physical Sciences : 4000
Physical Therapy: 2608
Physical Therapy Assist: 2613
Physician Asst.: 2614
Political Science: 4502
Practical Nursing: 5116
Preschool Education (Certificate) : 2007
Public Administration: 4505
Qualified 401K Administrator : 5132
Radiology Tech.: 2615
Registered Nursing: 5117
Retirement Plan Fundamentals : 5130
Respiratory Therapy: 2609
Secondary Education: 1302
Social Work : 4506
Special Education: 1306
Speech Communication: 2302
Sports Management: 1308
Tax Exempt Administrator : 5131
Technical Accounting Specialist: 5210
Technical Studies: 5134
Undecided-Major Not Declared: 0000
Veterinary Medicine: 2625
Welding Technology (Certificate)
Wildlife Science: 2616
Are you interested in participating in any of the following activities located on the Great Bend campus?
In compliance with Kansas Statute KSA 2009 Supp. 65-129, Barton Community College has instituted a tuberculosis prevention and control policy for students. Please answer the following questions.
If the answer is “YES” to ANY of the above questions, it is your responsibility to complete the following:
A hold will be placed on your attendance to all classes until the signed risk assessment has been provided. Return the Risk Assessment form to Student Health or Fort Riley Admissions prior to start of classes.
If answered "Yes", and classes are 100% online, no further testing or action is required
Turks & Caicos Islands
United Kingdom of Great
Britain & North Ireland
Antigua & Barbuda
United States Virgin Islands
United States of America
Wallis & Futuna Islands
St. Kitts & Nevis
British Virgin Islands
In accordance with federal regulations regarding Federal Financial Aid, applicants must be working toward a degree or certificate from the institution that you wish to receive federal aid from. To view additional Federal Financial Aid regulations, click here
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. *
To provide equal employment, advancement and learning opportunities to all individuals, employment and student admission decisions at Barton will be based on merit, qualifications, and abilities. Barton County Community College does not discriminate on the basis of any characteristic protected by law in all aspects of employment and admission in its education programs or activities. Any person having inquiries concerning Barton County Community College’s non-discrimination compliance policy, including the application of Equal Opportunity Employment, Titles IV, VI, VII, IX, Section 504 and the implementing regulations, is directed to contact the College’s Compliance Officer, Barton County Community College, Room A-123, Great Bend, Kansas 67530, (620) 792-2701. Any person may also contact the Director, Office of Civil Rights, U.S. Department of Education, Washington, DC 20201.
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
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.
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