Barton College




WEEKEND COLLEGE FOR PARENTS

Application For Admission

Personal Information
First Name:
Middle/Maiden Name:
Last Name:
Name you wish to be called:
Street Address:
 
City:
State: County
Zip:
Phone: [REQUIRED]
Email: [REQUIRED]
Please list the best time for an admissions counselor to contact you:
Social Security Number:
[Last 4 digits only]
Gender: Male   Female
Date of Birth: - -
Place of Birth
City:
State:
Country:
Marital Status:
Religious Affiliation: No preference
Ethnic Background:
Student Information
To help us verify your eligibility to take a free course, please submit the following information about the Barton student connecting you with this educational opportunity.
First Name: [REQUIRED]
Middle/Maiden Name: [REQUIRED]
Last Name: [REQUIRED]
Date of Birth: - -
Enrollment Information
Transfer Students Are you eligible to return to the institution you last attended?
Yes   No  
Reason for Leaving
I am enrolling for this term:
I am interested in this fall course:
 
I am interested in this winter course:
Have you applied for admission to Barton College previously?
Yes   No  
Employment Information
Employer
Street
City
State:
Zip:
Work Phone: [REQUIRED]
Please enter "n/a" if you have no work number.
Family and Friends:
Please list members of your family and friends who have attended or who are currently attending Barton College. Give relationship.
Name
Relationship
Name
Relationship
Emergency Contact
Name
Phone:
Cell:
Address:
Relationship:
Educational Background:
List all high schools and colleges you have attended or are attending and specify dates. Include summer school, correspondence courses, extension programs or other postsecondary education.
School 1
City
State
Dates Attended
Graduation Date
Degree/License
School 2
City
State
Dates Attended 
Graduation Date
Degree/License
School 3
City
State
Dates Attended
Graduation Date
Degree/License
School 4
City
State
Dates Attended
Graduation Date
Degree/License
If you did not or will not graduate from high school, have you successfully completed a testing or equivalency program? Yes   No  
Applicant Certification:
Have you been convicted of a criminal offense other than a minor traffic violation?
Yes   No  
Are there such criminal charges pending against you at this time? Yes   No  
Have you ever been dismissed, suspended or placed on probation by any school? Yes   No 
(If you answered “yes” to any of these three questions, please explain the circumstances below. Your application will not be acted upon unless an explanation is provided.)
I agree to abide by all rules and regulations as published in the College Catalog, Student Handbook and other official publications. I certify that I have not been a full-time student in a four-year college or university, including Barton College, during the past 12 months (graduates excluded).
Honor Code:

Barton College expects all students to adhere to the principles outlined in the Student Honor Code: To the best of your ability never knowingly or willingly lie, cheat or steal; to support in word and deed the concept and principles of the Honor System and to discourage those who would not. The College also expects all students to adhere to the principles expressed in the Student Honor Code as it appears in the College Catalog, Student Handbook and other official publications. I affirm on my honor that all of the above information is complete and accurate and that I will read the rules and regulations as published in the Barton College Catalog and I will agree to abide by them. I understand that providing false or incomplete answers may disqualify me from admission to or terminate my enrollment at Barton College.

Additional Required Documents:

•Official SAT Scores or ACT Scores
Not required of transfers or individuals who have been out of high school more than three years
•Official Transcripts
Sent from other institutions

Mail these documents to:
Office of Lifelong Education and Extended Programs, Barton College, Box 5000, Wilson, NC 27893-7000.
Questions? 1-800-767-6305