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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 |
| 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:__________ |
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I-20 admission #:________________
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Social Security #:________________
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| 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. |
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If no, what is your current occupation?
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| 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: |
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| 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 |
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Please send official score report for verification. Copies of the score report will not be accepted.
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| 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. |
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| List names and addresses of people you know who are currently attending Emporia State University or living in Emporia or the United States: |
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| 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
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| Required items in addition to this application: |
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