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Barton County Community College
Veteran's Notice of Intent to Enroll

Fort Riley Campus (785) 784-6606 or (877) 620-6606

* required fields
1. *Name: 2.*Soc.Sec. Number
3. *Address: 4. *Work Phone:
5. *City: 6. *Home Phone:
7. *State: 8. *Zip:
9. VA File Number: (Veteran's Soc. Sec. Number)
10. *E-Mail Address:
11. *

Chapter 31 Only - VA Counselor's Name:

VA Counselor's Address (City, State):

12. *Declared Major at Barton County Community College:
(Example: AA - Political Science)

If you are NOT pursuing a degree at Barton County Community College, name your *Primary School where you are currently earning your degree:
(School, City, State)
You will be required to provide a *Parent School letter from the school listed above.

13. *Indicate the Semester in which you are enrolling and the number of hours you plan to take:
(Choose ONE semester only - fill out a seperate online form for each semester)
Fall: Spring: Summer:

14. *List the Courses you are taking this semester.
(list only Courses that apply toward the Degree program you listed in item 12.)

Course Reference Number Course Title Number of Credit Hours
If Barton County Community College is not your *Primary School, you do not need to fill out the rest of this form. Go to item 18.
15. *Advisor's Name:
16. *Will you be taking courses at another school to apply to your degree at Barton County Community College for which you wish to receive VA Educational Benefits? Yes: No:
IF YOU MARKED YES, please fill in the following:

School Name and Address:

Name of contact person at *Primary School:

Email address of contact person:

List Courses:
Course Reference Number Course Title Number of Credit Hours
If the courses listed above will apply to the degree in item 12, we will send a *Parent School letter to the Secondary school so that they can certify your enrollment for VA Educational benefits.
17. *Do you have college credits from any school other than Barton County Community College?
Yes: No:

IF YES, please list the colleges (with city and state) you have attended other than Barton County Community College.

School Name City & State Degree/Hours Earned
Please have these schools send your transcripts to our Enrollment Services Department.
18. If you DO NOT wish to receive Break Pay between semesters, check here. No
You will receive Break Pay where entitled unless "No" is checked.
Payment for breaks DOES count against basic entitlement.
*Parent School letter - this is a letter from your primary school listing the courses you are taking at the Secondary School and verifying that they will apply to your degree at the Primary School.
*Primary School - the school from which you will receive your degree.

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