PS Application

Southwestern College Professional Studies
Application for Admission

If you are unable to fill out this application, please contact an admissions representative at enrollment@sckans.edu and they will assist you.

Name*

First Name

Last Name

Maiden/Other Name

Home Phone*

Mobile Phone

Email*

Street Address*

City*

State*

Zip Code*

Gender

Date of Birth*

Are you a U.S. citizen?*

Social Security Number (U.S. Citizens Only)

Numbers only (no dashes)

Ethnicity

Hispanic/Latino?

Are you currently incarcerated or under house arrest?

Currently incarcerated or under house arrest?

I am currently incarcerated or under house arrest.

Academic Information

Program Level*

Program*

Anticipated Start Year

Anticipated Start Session

Have you previously attended an institution of higher education?

College 1 Information

College 1 Name

College 1 State

College 1 Graduation Year

College 1 Degree Obtained

College 2 Information

College 2 Name

College 2 State

College 2 Graduation Year

College 2 Degree Obtained

College 3 Information

College 3 Name

College 3 State

College 3 Graduation Year

College 3 Degree Obtained

Employment Information

Are you currently employed?

Employer Name

Employer City

Employer State

Position Title

Are you a current or former member of the armed forces or a dependent of a member?

Branch

Status

Tuition Payment Information (check all that apply)

Cash

Tuition Reimbursement

VA Benefits

Financial Aid

Tuition Assistance

Other

Location

Date/Time

Title IX of the Education Amendments of 1972 prohibits sex discrimination in education, including sexual harassment. Southwestern College acknowledges its obligation under Title IX and is committed to complying with all Title IX requirements. The Title IX Coordinator is responsible for coordinating the college’s compliance with Title IX, including the school’s grievance procedures for resolving Title IX associated complaints. Title IX Coordinator: Lonnie Boyd, Director of Human Resources, 100 College Street, Winfield, KS 67156, 620-229-6136, lonnie.boyd@sckans.edu.