Scholarship Form

BARTON COUNTY SCHOLARSHIP APPLICATION FORM
Fall 2008: Deadline August 11, 2008
Spring 2009: Deadline December 3, 2008

Please complete the following form. When you are finished, please select print at the bottom of the form.

Name:		Birth date:
Home address:		Home phone:
		Work phone:

E-mail:
Major:

Semester:

K-State:
	Number of K-State hours enrolled for semester:	(minimum number of credit hours: 3)
	Total number of K-State hours completed:		Undergraduate GPA:
Barton County:
	Number of Barton hours enrolled for semester:	(minimum number of credit hours: 3)
	Total number of Barton hours completed:		Undergraduate GPA:
*Barton classes include on campus classes, BartOnline classes and EduKan classes. **K-State classes include distance education classes (online or Telenet 2)

Signature:__________________________________________			Date:_____________

*Return to:*	K-State at Barton
	245 NE 30 Rd
	Great Bend, KS 67530

If you have any questions, please call 620-786-1188 or email bartondce@k-state.edu.