Student Application

Complete this application if you are seeking admittance into a certificate program.

First Name This field is required

Last Name This field is required

Email This field is required Invalid Format

Phone This field is required Invalid Format

Address This field is required

Address Line 2

City This field is required

State This field is required

Zip Code This field is required

Are you a US citizen This field is required

If no, what is your resident status?

Highest Level of Education This field is required

Are you a veteran or current military? This field is required

Area of Study This field is required

Desired Start Date This field is required Invalid Format

How did you find out about us? This field is required

If military, were you honorably discharged? If no, please explain.

Have you been convicted of any crimes? If yes, please explain. This field is required

I understand that I must relocate to Manhattan, Kansas to attend the SAVE Farm Program if I do not live near facilities. This field is required

I understand

I affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission of any facts called for in the application may render this application void and will be cause for termination, whenever discovered.

I affirm

	(785) 775-1212
	info@savefarm.org
	9680 N. 52nd Street, Riley, KS 66531