Request For Graduate Information

So that we can provide you with information, please take a moment to fill out the following form. Please make sure to complete all the required fields marked with an asterisk and check all items that pertain to your interests in a graduate school experience. If your browser does not support forms, please contact us by email, fax, letter or phone.

Office of Graduate Studies
Emporia State University
1200 Commercial
Emporia, Kansas 66801
620-341-5403
1-800-950-GRAD
e-mail: gradinfo@emporia.edu
FAX 620-341-5909

NOTE: International Students -- Please Do Not Complete This Form. International Students Must Contact The International Education Office For Information.

* Asterisks denote required fields

Personal Information

*First Name:

*Last Name:

*Address:

*City:

*State:

*Zip Code:

Phone Number: (optional)

*Email Address:

*Confirm Email Address:

Birth Date: (optional)

Social Security Number: (optional)

Race: (optional)

Gender: (optional)


Educational History

Please complete the information below for your undergraduate degree.

*Have you attended ESU previously:

*Name of School Bachelor's Degree Obtained At:

*Bachelor's Degree Obtained:
(BS,BA,BIS,BSE,BGS, etc.)

*Date Graduated: (mm/yyyy)
(If you have not yet completed your degree, please list anticipated graduation date)

First Semester at ESU:



Interest Information

*Academic Interest - First Choice:

Academic Interest - Second Choice:

Additional Comments/Questions:


All information you submit will be transmitted securely, will remain confidential, and will only be used by Emporia State representatives to better enable us to assist you in the application and admissions process. Although this information is required for electronic graduate information, you do not need to provide it to get information. Please feel free to call 800-950-GRAD to receive graduate information by other means.



Emporia State University Home Page| Graduate Home Page

Last updated 01/25/10
by: Peggy Anderson
e-mail: andersop@emporia.edu