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 complete 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 Office (620) 792-9286 or 800-722-6842.
When do you plan to enroll?
Primary Campus:

Complete Legal Name:
Last: First: Middle:
Previous or Maiden Name:
Address: City:
State: Zip: Phone Number:
E-Mail address:
Sex: Male

Date of Birth(MM/DD/YYYY):

Ethnicity (Data used for reporting purposes only)

Are you Hispanic or Latino? Yes No

What is your race? (If applicable, check all categories of race that best describe you)

American Indian or Alaskan Native
Native Hawaiian or Other Pacific Islander
Black or African American Hispanic or Latino

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

Are you affiliated with the military? Yes No
If so:

Active Active Family Member
DOD DOD Family Member
Reserve/Guard Reserve/Guard Family Member
Veteran Veteran Family Member

If Other, Please Specify:

Would you like to be contacted by the Disability Services Office? Yes 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.

Are you a Kansas resident? Yes No

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.


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 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):


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):

ACT Scores: Composite:

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? Yes No
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.

Name City State

Enrollment Information:

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:



Are you interested in participating in any of the following activities located on the Great Bend campus?

Academic Club
Athletic Trainer
Campus Christian Fellowship
Cheer Squad
Community Student Organization
Dance Team
Hispanic Leadership Organization
Honors Program
Multi-Cultural Society

Student Ambassador
Student Government

Theatre Arts

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.

1. Have you ever had a positive result on a tuberculosis test?
(skin test, blood test, chest x-ray)
Yes No
2. Have you ever had close contact with anyone who was sick with TB? Yes No
3. Were you born in a country NOT listed below?
If you were born in the United States, the answer is NO!
Yes No
Name of birth country:
4. Have you ever traveled and spent over 3 months to a country NOT listed below?
If yes, please list countries traveled and time spent there:

Yes No
If the answers to the questions are "NO"---no further testing or action is required

If the answer is “YES” to ANY of the above questions, it is your responsibility to complete the following:

  1. Receive a completed Tuberculosis Risk Assessment which includes TB testing.
  2. The TB Risk Assessment may be obtained at BCC Student Health, local Health Departments or physician/health clinics. 
    1. The assessment form utilized may be downloaded from Student Health.
    2. Military personnel and military family members will use the DoD Immunization Record to document the results of the testing and outcome of positive results.)         

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.

Are your classes 100% online: Yes No

If answered "Yes", and classes are 100% online, no further testing or action is required


Birth or travel in any country NOT listed below requires a Yes answer to the above questions.


Czech Republic


Turks & Caicos Islands  

American Samoa



United Kingdom of Great




Britain & North Ireland

Antigua & Barbuda



United States Virgin Islands



New Zealand

United States of  America 




Wallis & Futuna Islands



St. Kitts & Nevis





St. Lucia




British Virgin Islands









Costa Rica






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. *


Non-Discrimination Notice:
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.


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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