When do you wish to enroll? Year: _________ January(Spring) June (Summer) August (Fall)
 
Name as it will appear on your legal documents:
_______________________________________________________________________________________
 
Last (Family) First Middle

________________________________________________________________________________________

Mailing address: street and number City State/Province Postal code Country

 ________________________________________________________________________________________ 

Permanent address (home country): street and no City State/Province Postal code Country

________________________________________________________________________________________
  ________________________________________________________________________________________
Sex (M/F) Date of Birth
(mo./day/year)		 Place of Birth
(city and country)		 Country of Citizenship

________________________________________________________________________________________
Other names that may appear on your academic records
(Include country and area/city code for both Phone and Fax)
_________________________________________________________________________________________
 
Telephone Fax Email

_____________________________________________________________________________________________

Program of study
_________________________________________________________________________________________
 
Degree Major(s) Area(s) of study
_____________________________________________________________________________________________

Visa type you plan to hold during your study at E.S.U.
 
(F-1) Student (J-1) Exchange Visitor Other:__________
 
______________________________________________________________________________________________
 
  • If you are in the U.S. now, please send a copy of your original I-20 or DS-2019.
    		•
    I-20 admission #:________________
  • If you are a US Immigrant, please attach a copy of your Alien Registration Card.
    		•
    Social Security #:________________

     

     

     

    Marital status: Single Married (If married, please list family members who will accompany you to E.S.U.)
       
    Name Relationship (spouse, child) Date of Birth Place of Birth Sex: Male/Female

    ________________________________________________________________________________________

    ________________________________________________________________________________________

    ________________________________________________________________________________________

    ________________________________________________________________________________________


    Educational history: List, in order of attendance, every school you have attended. Include each primary, secondary, and post-secondary institution you have attended or plan to attend before enrolling at Emporia State University.
       
    Name of institution attended Location
    (city & country)    		 Dates attended mo/yr - MO/yr Certificates, degrees, diplomas Date Received

    _______________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    Please attach a separate page if you need to list additional schools.
    Are you currently a student? Yes No
     
    If yes, please be sure to include your current school in the educational history section above.
    If no, what is your current occupation?_________________________________________________________________

    Financial Information
    You are required to certify that you will have available US$ 21,000 for your own expenses for your first academic year (9 months) of study at Emporia State University. This does not include travel expenses. You should also indicate how you will meet your expenses for subsequent years of study if you expect your program to require more than one year. Students who plan to attend classes during the Summer session will need an additional $5,400.
    List the amount that you will have available for your first year of study at Emporia State University. US$______________________
    All bank statements, scholarship award letters, affidavits of support, etc. must have been issued within 6 months of the time you apply for admission.
    Attach verification of statements from banks, employers, private, and/or government sponsors.
    All documents must:
  • be on official letterhead, 
  • be signed by an official representative, 
  • state the amount of support (in US$), 
  • carry the necessary official stamp and seal of the bank or sponsoring agency. 
    		•
     
    Kinds of financial support you will have available for your study at Emporia State University:
    Personal Savings My family My government Sponsor Other:
     
    _________________________________________________________________________________________
    A Certificate of Eligibility (I–20 or DS-2019) cannot be issued until an Official Statement of Financial Support or a Bank Statement is received.
    English Proficiency
    TOEFL
    Other:
     
    _____________________________________________________________________________________________
     
    English test taken Score (if available) Date taken (month/day/year) Native language
      _____________________________________________________________________________________________ ________________________________________________________________________________________
    Please send official score report for verification. Copies of the score report will not be accepted.
    Housing Financial Aid
    Please send me information about on-campus university housing. Please send me information about off-campus apartments.
    Please send me information about on-campus employment. Please send me information about scholarships.
    List names and addresses of people you know who are currently attending Emporia State University or living in Emporia or the United States:
    ____________________________________________________________________________________________
    ____________________________________________________________________________________________
    ____________________________________________________________________________________________
    Note to the Applicant
    I hereby affirm that all information supplied on this form is complete and accurate. I understand that I will not be considered for admission until I have submitted all the required items listed below.
       
    Date (mo./day/year) Signature

    Required items in addition to this application:
     

    Transcripts
    Financial statement
    English Proficiency Score (if available)
    Letters of recommendation
    Letter of purpose
    Photocopy of passport information page
    Application/processing fee 
    • undergraduates (US$50)
    • graduates (US$75)
     
     
     
    Office of international Education         
    Emporia State University                     
    1200 Commercial St.
    ESU Box 4041                                      
    Emporia, KS 66801-5087, U.S.A.        
    Telephone: (620)341-5374               
    Fax: (620)341-5918               
    E-mail: oisa@emporia.edu            
    Web Page: http://www.emporia.edu/oie