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Employee Scholarship Application

Student Information
Name:* ID/SSN:*
Phone:* Email:*
Address:* City:*
State:* Zip:*
Student Classification:*    

Employee Information (Note: If the student and employee are the same person, this information is not required.)

Employee Name:

Employee ID/SSN:



Terms & Conditions
  • Student must be maintaining Satisfactory Academic Progress (SAP) as outlined at this link http://www.bartonccc.edu/financialaid/sap.pdf.
  • LSEC and Non-credit classes are not eligible.
  • Resident tuition is paid for online classes.
  • Recipients of the employee tuition scholarship will not be elgible for the Over 65 or Silver Cougar Club tuition discount.
  • Eligible dependent children for the full-time staff and full-time faculty categories are defined as those children claimed on the employee's or, in the event of divorce, dependents of the employee and their ex-spouse at the time the two were married and claimed on their parent's most recently filed federal tax return. Misrepresentation of a qualifying dependent will result in the permanent loss of the Tuition Scholarship benefit.

 I certify that to the best of my knowledge the information on this form is true and complete without evasion or misrepresentation. I understand that if found to be otherwise, it is sufficient cause for rejection.*

By checking this box you have created an electronic signature as legally binding as your handwritten signature.