Online Degree Program
Web Application


PERSONAL INFORMATION

Name: Last   First   Middle  Maiden

Mailing Address   City   State  Zip    

County   

Phone numbers must be entered in xxx-xxx-xxxx format.
Home Phone   Work Phone  
Cell Phone   Email  

Date of Birth    (mm-dd-yyyy format)
Gender:
Marital Status  

Social Security Number    (xxx-xx-xxxx format) 

Barclay is required to collect information on race by the US Department of Education. Please select one of the following races:








Home Church (Denomination)  


 
If Other, please enter your denomination.

Emergency Contact (optional)
 
Name (first and last)  Telephone    (xxx-xxx-xxxx format) 
Address  
City  State  Zip  

EDUCATION
Please list all high schools and colleges or universities you have attended.

High School Name City: State: Zip: Graduation Year
1

 

   
2  
3  

 

College Name City State Zip Dates of Attendance Diploma or Degree Hours of Credit
1

2
3

You must have an official transcript sent to Barclay College directly from each institution you have attended, regardless of the amount of credit earned.

REFERENCES
Including an e-mail address allows us to contact your references if necessary to keep your application moving forward.

Reference #1
Name    Address   
City   State  Zip    E-mail  

Reference #2
Name    Address  
City   State  Zip    E-mail  

Send this link to your references for them to fill out online OR the alternative is to download and print this form and give it to your references.

Christian Faith. Tell what it means to be a Christian, give an account of where you see yourself spiritually, and explain the significance of the Christian faith for education and life. (250 words or more recommended)   

ENROLLMENT INFORMATION

How did you hear about the Barclay Online program?  

Please select your major or intended course plan:
Majors:





Anticipated start date:

I understand that completing this application does not mean acceptance. By filling in my name and the date below, I verify that all information contained in my application is correct.
Applicant's Signature
Full Name  
Date   (mm-dd-yyyy format) 

 

Barclay College considers all applicants without regard to race, color, national or ethnic origin, age, gender, or physical disability.

Barclay College is a four-year Bible College founded in 1917. The college is accredited by the Association for Biblical Higher Education, and offers both traditional and continuing education at the main campus in Haviland, Kansas, adult degree completion options through the Online and Advantage! Programs, home college courses, and other educational opportunities. Inquiries regarding the many programs of Barclay College are always welcome, and may be directed to the Office of Admissions.