drives
Document Sample


WHAT Admission & Scholarship
Application
drives
YOU?
1. There is no application fee. 5. Students entering college for the first
time, pursuing a certificate or degree,
2. Complete the Admissions or enrolling in a class requiring
application. Answer all test scores must have ACT,
questions. Do not SAT, Accuplacer or ASSET
leave any questions scores on file with
blank. NOTE: If you Barton. These scores
are an international are used for placement
applicant, please in English, Reading, and
visit our website for Math courses. Students
International student without test scores
information and must take the Accuplacer
application. or ASSET test. (Fort Riley
www.bartonccc.edu/ students may submit or take the
prospective/typeoflearner/international Compass test). Barton’s assessment
is free of charge. Contact the Testing
3. All degree/certificate seeking students
Center at (620) 792-9344 or 800-748-
must have official post-graduation
7594 for a testing schedule or further
transcripts (high school, home school,
information.
or proof of GED) from each institution
attended sent by the granting 6. To be considered for the Barton
institution directly to Barton. Home Academic Scholarship Award,
school credit evaluations may be complete the application section
submitted in lieu of a transcript or inside this form. This scholarship
diploma from the school administrator. application deadline is March 15
NOTE: Student will be admitted as a for the following academic year.
“Special Student” until all transcripts
from previously attended institutions are 7. Anyone seeking an accommodation
received and evaluated. under provisions of the Americans
with Disabilities Act should notify
4. If you are applying to the following Student Support Services by calling
areas of study, you may need to meet (620) 792-9240 or e-mailing
additional admissions requirements. studentsupport@bartonccc.edu.
Contact or visit the respective area for
more information. 8. Return this application to the address
http://programs.bartonccc.edu listed below.
• Medical Laboratory Technician Barton Community College
Admissions Office
• Medical Assistant 245 NE 30 RD
• Nursing Great Bend, KS 67530
• Paramedic (MICT)
(620) 792-9286 OR 800-722-6842 FAX: (620) 786 -1160 GoBarton.com
PROGRAMS OF STUDY
DEGREE CODES
Career Technical Education Programs Transfer Programs
AA Associate in Art NDS Non-Degree Seeking and not eligible for federal aid C and/or AAS AS, AA, and/or AGS
AGS Associate in General Studies SAPP Stand Alone Program
Career technical education offers students Transfer programs are
AS Associate in Science * Emphasis of Study the option of one or two-year programs designed to prepare you for
designed to provide knowledge and skills, transferring from Barton to a
AAS Associate in Applied Science + May be eligible for federal aid under correlating degree program
which will prepare them for employment� four-year college or university�
C Certificate Program ++ Not eligible for federal aid
CAREER TECHNICAL EDUCATION PROGRAMS TRANSFER PROGRAMS (Liberal Studies) TRANSFER PROGRAMS (continued)
Accounting - Technical Specialist (AAS) � � � � � � � � � � � � � � � � � � � � 5210 Accounting (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5201 Horticulture/Turf Management (AS) � � � � � � � � � � � � � � � � � � � � � � � 0216
Administrative Assistant* � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5205 Agribusiness (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 0108 Journalism (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 0901
Adult Health Care Agricultural Economics (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 0110 Law (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2200
Activity Director (NDS) ++ � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5119 Agricultural Education (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 0111 Law Enforcement (AS) * � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4310
Certified Medication Aide (SAPP) ++ � � � � � � � � � � � � � � � � � � � 5126 Agriculture Communications (AS) � � � � � � � � � � � � � � � � � � � � � � � � � 0109 Liberal Studies (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2402
Certified Nurse Aide (SAPP) ++ � � � � � � � � � � � � � � � � � � � � � � � � 5120 Agriculture Transfer Option (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � 0100 Management (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5224
Home Health Aide (SAPP) ++ � � � � � � � � � � � � � � � � � � � � � � � � � � 5121 Agronomy (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 0210 Marketing (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5220
Rehabilitation Aide (SAPP) ++ � � � � � � � � � � � � � � � � � � � � � � � � � 5122 Animal Science (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 0211 Math Education (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1307
Agriculture Business Management (AAS) � � � � � � � � � � � � � � � � � � � 0106 Anthropology Cultural Studies (AA, AS) � � � � � � � � � � � � � � � � � � � � 4504 Mathematics (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2701
Crop or Livestock Production* Architectural Engineering (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � 1403 Medical Laboratory Technician (AS) � � � � � � � � � � � � � � � � � � � � � � � � 5110
Automotive Technology (AAS, C) � � � � � � � � � � � � � � � � � � � � � � � � � � 4706 Architecture (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4801 Medical Technology (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2604
Business Administrative Technology (AAS) � � � � � � � � � � � � � � � � � � 5205 Art (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5001 Medicine (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2602
Administrative Assistant* Art Education (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1309 Military Studies (AGS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4507
Business Management and Leadership (AAS) � � � � � � � � � � � � � � � 5217 Athletic Training (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2610 Milling Science (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 0214
Business Technology (AAS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5225 Automotive Technology (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4707 Modern Languages (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1601
Computer Networking Specialist (AAS, C) � � � � � � � � � � � � � � � � � � 5215 Biology (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2630 Mortuary Science (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2605
Corrections (AAS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4306 Business (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5200 Music (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5004
Criminal Justice (AAS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4302 Business Computer Management (AS) ++ � � � � � � � � � � � � � � � � � � 5212 Music Education (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1305
Crop Protection (AAS, C) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 0104 Chemistry (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4001 Nursing – ADN (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5117
Dietary Manager (C) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2004 Chiropractic (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2601 Nursing Transfer (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2622
Early Childhood (AAS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2003 Computer Information Systems (AS) � � � � � � � � � � � � � � � � � � � � � � � 5213 Occupational Therapy (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2623
Emergency Management/Homeland Security (AAS, C) � � � � � � � 4508 Computer Science (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1101 Optometry (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2606
Emergency Services Education Criminal Justice (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4301 Park Management and Conservation (AS) � � � � � � � � � � � � � � � � � � 0215
Emergency Medical Services Administration (AAS) � � � � � � � � 1508 Cytotechnology (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2617 Pharmacy (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2607
Emergency Medical Technician - Basic (SAPP) + � � � � � � � � � � 5107 Dance (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5010 Philosophy (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 3801
Emergency Medical Technician - Intermediate (SAPP) ++ � � 5114 Dental Hygiene (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2611 Photography (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5005
First Responder (SAPP) ++ � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5113 Dentistry (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2603 Physical Education (Coaching/Recreation) (AA, AS) � � � � � � � � � � 1303
Mobile Intensive Care Technician (AAS) � � � � � � � � � � � � � � � � � � 5109 Dietary Management (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2006 Physical Sciences (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4000
Fire Science Technology (AAS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4303 Dietetics (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2005 Physical Therapy (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2608
Contact the EMS Office at (620) 792-9341 for details Drama (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5002 Physical Therapy Assistant (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � 2613
Graphic Design Multimedia Specialist (AAS) � � � � � � � � � � � � � � � � 5216 Early Childhood Education (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � 1304 Physicians Assistant (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2614
Hazardous Materials Management (AAS, C) � � � � � � � � � � � � � � � � � 1505 Economics (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5206 Physics (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4003
Manufacturing Skills Certificate (SAPP) ++ � � � � � � � � � � � � � � � � 1507 Elementary Education (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � 1301 Political Science (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4502
Medical Administrative Technology (AAS) � � � � � � � � � � � � � � � � � � 5209 Engineering (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1401 Pre-Nursing (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2621
Medical Assistant (AAS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5222 Engineering Technology (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � 1402 Psychology (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4201
Medical Coding (C) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5227 English (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2301 Public Administration (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4505
Medical Laboratory Technician (AAS) � � � � � � � � � � � � � � � � � � � � � � 5110 Environmental Compliance Concentration (AS) � � � � � � � � � � � � � � 1506 Radiology Tech (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2615
Medical Transcriptionist (C) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5223 Exercise Science (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2618 Religion (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 3802
Military Technology (C) ++ � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2901 Finance (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5211 Respiratory Therapy (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2609
Natural Gas Transmission & Distribution Technician (AAS, C) � � � 4606 Food Science (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 0212 Secondary Education (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1302
Nursing Forensic Science (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4311 Social Work (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4506
IV Therapy (SAPP) ++ � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5125 Forestry (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 0201 Sociology (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4503
Practical Nursing - PN (C) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5116 General Studies (AGS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2401 Special Education (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1306
Associate Degree Nursing – ADN (AAS) � � � � � � � � � � � � � � � � � � 5117 Geology (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4002 Speech Communication (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � 2302
Students passing the state exams become a Golf Course Management (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � 0213 Sports Administration (AA, AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � 1308
Licensed Practical Nurse or a Registered Nurse Graphic Design (AA) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5003 Veterinary Medicine (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2625
Pension Administration* (SAPP) ++ � � � � � � � � � � � � � � � � � � � � � � 5208 Health Information Management (AA, AS) � � � � � � � � � � � � � � � � � 2612 Wildlife Science (AS) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 2616
Phlebotomy Training (SAPP) + � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5111 History (AA) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4501
Tech Accounting Specialist (AAS) � � � � � � � � � � � � � � � � � � � � � � � � � � 5210
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) 792-9234� Any person may also contact the Director, Office of Civil Rights, U�S� Department of Education, Washington, DC 20201�
PERSONAL INFORMATION:
*Social Security Number _______ - _______ - _______ (Your social security number will not be used as your assigned college ID number.)
When do you plan to enroll? ❑ Fall (Aug-Dec) ❑ Spring (Jan-May) ❑ Summer (May-July) Year 20 ______
*Complete Legal Name ___________________________________________________________________________________________________
Last First Middle Previous or Maiden Name
*Address _______________________________________________________________________________________________________________
Legal address City State Zip
*Phone Number: __________________ Cell Phone Number: __________________ *E-Mail address: __________________________________
*Sex: ❏ Male ❏ Female Date of Birth: ________________________________
Month/Day/Year
Emergency Contact Information: _________________________________________ ____________________________ ____________________
Name Relationship to Student Phone
Do either of your biological or adoptive parents have a bachelor’s degree? ❏ Yes ❏ No
Are you a member of the military family? ❏ Dependent ❏ Active Duty ❏ Other ❏ No
ETHNICITY (Data used for reporting purposes only)
Are you Hispanic or Latino? ❏ Yes ❏ No
What is your Race? (Check all categories of race that best describes you.)
❏ American Indian or Alaskan Native ❏ Asian ❏ Black or African American ❏ Hispanic or Latino
❏ Native Hawaiian or Pacific Islander ❏ White
*RESIDENCY STATUS:
NOTE: 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. For
additional residency information, visit http://bartonccc.edu/prospective
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
*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 ❏ Non-H.S./Non-GED Student
________________________________________________________________________________________________________________________
High School/Home School/GED Center City State Zip
High School/Home School Graduation Date: _______________________________ GED Certificate: __________________________________
Month/Year Month/Year of Completion
BARTON ACADEMIC SCHOLARSHIP AWARD APPLICATION
Application deadline is March 15 for the following academic year.
The Academic Scholarship Award will be awarded to graduates of Kansas high schools or other Kansas residents who received 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: ______
Disclaimer: We must have an official high school transcript, ACT test scores, or GED test scores to award the final award.
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 $1,000 a year.
*Information will be used for both Admission and Scholarship purposes.
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
ENROLLMENT INFORMATION:
Student Type: Check one only
❏ First Time Freshman ❏ Continuing/Former Barton Student ❏ Transfer to Barton ❏ Other ______________________
Please Specify
Are you seeking a certificate and/or degree from Barton Community College?
❏ Certificate ❏ Degree ❏ Both ❏ Neither
PROGRAM(S) OF STUDY (Academic Interests): ___________________________________________________
INTERESTS:
Are you interested in participating in any of the following activities:
❏ Academic Club ❏ Hispanic Leadership Organization ❏ Athletic Trainer ❏ Soccer - Men
(Area of Interest:_______________) ❏ Honors Program ❏ Baseball ❏ Soccer - Women
Detach along the fold line
❏ Band ❏ Multi-Cultural Society ❏ Basketball - Men ❏ Softball
❏ Campus Christian Fellowship ❏ Newspaper ❏ Basketball - Women ❏ Tennis - Men
❏ Cheer Squad ❏ Student Ambassador ❏ Cross Country - Men ❏ Tennis - Women
❏ Community Student Organization ❏ Student Government ❏ Cross Country - Women ❏ Track - Men
❏ Dance Team ❏ Theatre Arts ❏ Golf - Men ❏ Track - Women
❏ Debate ❏ Vocal ❏ Golf - Women ❏ Volleyball - Women
❏ Forensics
❏ Other: _______________________
I certify that the information given is correct and complete. 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 Community College, I agree to abide by the rules and regulations of the college regarding conduct, financial,
and other obligations.
STUDENT SIGNATURE: _________________________________________________________ DATE: ___________________
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