Heartland CAMP Application: First Year Scholars Program

Please complete the application questions below. The online application must be completed at one time, and cannot be saved. All information will remain confidential, and will be used for eligibility determination, demographic recordkeeping, federal reporting, and other administrative purposes only.

Student Information

First Name

Last Name

Preferred Name

Birthday (mm/dd/yyyy)

Gender

Male
Female
Non-binary / third gender
Prefer not to say

Phone Number

Personal Email Address

Street Address

City

Zip Code

Education Information

Which of the following Heartland CAMP colleges or universities are you interested in attending? (Check all that apply)

Kansas City Kansas Community College
University of Nebraska Omaha
University of Kansas
Western Iowa Tech Community College

Please list high school(s) attending, or have attended:

Date of high school graduation or GED/HiSET completion (mm/yyyy):

Have you ever participated in either the Migrant Education Program or National Farmworker Jobs Program?

Yes
No
Unsure

Have you or one of your parents/guardians worked as a seasonal farmworker for at least 75 days during the last 2 years?

Yes
No
Unsure

Are you a U.S. citizen or permanent resident?

Yes
No
Unsure

Have you already submitted the Free Application for Federal Financial Aid (FAFSA)?

Yes
No
Unsure

Will you be a first-generation college student, meaning neither of your parents/guardians has earned a 4-year bachelor’s degree?

Yes
No
Unsure

To which of the following Heartland CAMP partner institutions have you applied for college admission? (Check all that apply)

Kansas City Kansas Community College
University of Nebraska Omaha
University of Kansas
Western Iowa Tech Community College
I have not yet applied

Tell Us About Yourself

Briefly describe your educational goals and what inspires you to pursue a college education. How will participating in Heartland CAMP help you reach your educational goals?

Consent and Release

To the best of my knowledge, all information provided on this application is accurate. I authorize Heartland CAMP to request and obtain the following information/records in order to 1) verify my eligibility for Heartland CAMP participation, and 2) assess my academic and financial needs/strengths:

Migrant Education and/or National Farmworker Jobs Program participation records, if applicable
Financial Aid (FAFSA) application and award data
High school transcripts
College transcripts and/or enrollment records, if applicable

I have read and agree with the Statement of Consent and Release

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Please type your full name in the box below to sign the form.

Today's Date (mm/dd/yyyy)