Admissions
Barton Home | Prospective Student Home

Barton County Community College
Online Enrollment Form

Great Bend, KS 67530
(620) 792-2701 or 800-748-7594
Fort Riley Campus (877) 620-6606

*Anticipated date of entry to Barton County Community College:
*Year
Check any that apply:
Barton staff/dependent
Name of Barton Employee
Barton County resident 65 or over
Fort Riley Only:
Military Family Member Civilian
Personal Information
Social Security Number* (111-11-1111)
Date of Birth* (mm-dd-yyyy)
Legal Name
Last Name:*
 First Name:*
 MI:*
Maiden or Alternate Name:
    
Legal Address
Number and Street*
City*
County*
State*
Zip Code*
Home Phone * (111-111-1111)
Employer Name
Work Phone (111-111-1111)
E-mail *
(If you do not have an e-mail address, type "none" in the text field.)
Sex:* Male Female
Race*  
Are you a U.S. Citizen?* Yes No
Are you a Kansas resident?*
Date State residence began (mm-dd-yyyy)
Date County residence began (mm-dd-yyyy)
High School from which you did or will graduate:*
High School:
City: State: Year: (yyyy)
OR GED Graduate: Yes No
Do you hold a College Degree? Yes No
If yes, what type?
Program of Study Code:
If you are a secondary education major, please select an area of concentration from the drop down menu.