Jenzabar University

SECTION ONE: Personal/Demographic Information (required of all applicants)

First:

Middle/MI:

Last: 

Previous or Maiden Name:

Mailing Address:

City:

State:

Zip:

Student ID#:

Social Security or Alien Registration #:

Date of Birth:

Email Address:

Phone Number:

Major:

SECTION TWO: Academic History

Please list the high school you attended.

Date of High School Graduation:

Name of high school:

City:

State:

Please list all colleges or universities you attended.

Date last attended college/university:

Name of college:

City:

State:

Name of college:

City:

State:

Name of college:

City:

State:

SECTION THREE: Policy Certifications (required by all applicants)

I certify that the answers I have given on this application are accurate to the best of my knowledge.  Failure to provide accurate and complete information may cause me to be ineligible for DC3 Scholarships.  I have read these policies and information.  I certify that I understand the requirements for receiving and renewing my scholarship.

Applicant's Signature: 

Date: 

FOUNDATION SCHOLARSHIPS: Recommended but NOT Required

A list of available Foundation Scholarships can be found at: https://dc3.edu/foundation-alumni/foundation-scholarships/  Please include an essay outlining your future plans, major, interests, and financial considerations.

Foundation Scholarship desired: 

Upload your essay here: 

NOTICE OF NON-DISCRIMINATION - Dodge City Community College does not discriminate on the basis of race, color, national origin, sex, disability or age in its programs and activities.  The following persons have been designated to handle inquiries regarding non-discrimination policies:  Federal Compliance Administrator, 2501 N. 14th Avenue, Dodge City, Kansas 67801, (620) 227-9119 (compliance@dc3.edu) or Director of Human Resources, 2501 N. 14th Avenue, Dodge City, Kansas 67801, (620) 227-9201, (compliance@dc3.edu).