International Student Application Form

Emporia State University International Student Admission Application

To apply online, please fill out the following form and submit it by clicking on the submit button at the bottom.
Then print off the signature block, sign it, and mail it to our office with all the required attached documents. The following form performs best using JavaScript-enabled Netscape 4.06 and above or Internet Explorer 4.0 and above browsers. If this form does not work on your browser, try our printable applications.
*Please fill out the entire form. Every field is required and any item that is left blank will result in an error.

When do you wish to enroll?

Year: Semester: [ Fall (August) ] [ Spring (January) ] [ Summer (June) ]

Personal information

Name as it will appear on your legal documents:
Last (Family) name: First name:
Middle name:

Mailing address (street and number):

City:

State/Province:

Postal code:

Country:

Permanent address (home country) street and number:
City:	State/Province:

Postal code:

Country:

Date of Birth:
Month of birth	Day of birth	Year of birth

Sex: [ Male ] [ Female ]

Place of Birth (city and country):

Country of Citizenship:

Other names that may appear on your academic records
Other Name:

(Include country code and area/city code for both Phone and Fax.)
*Format is set up for numbers only. Do not include dashes.

Telephone number:

Fax number:

E-mail:

Enrollment Information

Programs of study

Degree Desired:

Before filling out the next two boxes, please read our complete list of programs of study. (Opens new window)

Major or Majors:

Area of Study:

Visa type you plan to hold during your study at E.S.U.:

[ (F-1) Student ] [ (J-1) Exchange Visitor ] [ Other: ] Please specify Visa type.

If you are in the U.S. now, please attach a copy of your original I-20 or DS-2019 to your signature block.

If you are a US Immigrant, please attach a copy of your Alien Registration Card to your signature block.

I-20 admission number: Social Security number:

Family Information

Marital status:
[ Single ]
[ Married ](If married, please list relatives who will accompany you to E.S.U.)

Example: Fill out your relative's information in the same manner shown below. First Relative's Name: Sarah Smith. Realtionship(Spouse/child): Spouse. Relative's Date of Birth: 05/09/79. Place of Birth (city and country): Paris, France.


First Relative's Name:	Relationship (Spouse/Child)	Relative's Date of Birth:	Place of Birth (city and country):	Sex: Male/Female
Second Relative's Name:	Relationship (Spouse/Child) :	Relative's Date of Birth:	Place of Birth (city and country):	Sex: Male/Female
Third Relative's Name:	Relationship (Spouse/Child) :	Relative's Date of Birth:	Place of Birth (city and country):	Sex: Male/Female
Fourth Relative's Name:	Relationship (Spouse/Child):	Relative's Date of Birth:	Place of Birth (city and country):	Sex: Male/Female
Fifth Relative's Name:	Relationship (Spouse/Child):	Relative's Date of Birth:	Place of Birth (city and country):	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.

First school attended:	First school location (city & country):	Dates attended (month/year):	Certificates, degrees, diplomas:	Date Received:
Second school attended:	Second school location (city & country):	Dates attended (month/year):	Certificates, degrees, diplomas:	Date Received:
Third school attended:	Third school location (city & country):	Dates attended (month/year):	Certificates, degrees, diplomas:	Date Received:
Fourth school attended:	Fourth school location (city & country):	Dates attended (month/year):	Certificates, degrees, diplomas:	Date Received:
Fifth school attended:	Fifth school location (city & country):	Dates attended (month/year):	Certificates, degrees, diplomas:	Date Received:

Please attach a separate page to your signature block 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 in US currency $22,000 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 of funds that you will have available for your first year of study at Emporia State University in US currency: US$ . *Format is set up for numbers only. Do not include dollar sign or commas.

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 to your signature block.

All documents must:

be on official letterhead,
be signed by an official representative,
state the amount of support (in US currency),
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: ]Please Specify other kind of financial support.

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 Test:

[ T O E F L ]
[ Other ]

English test taken:

Score (if available):

Date taken (month/day/year):

Native language:

Please send official score report for verification with your signature block. Copies of the score report will not be accepted.

Housing:	Please send me information about on-campus university housing.	Please send me information about off-campus apartments.
Financial Aid:	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:

Example: Fill out this list in the same manner shown below. First Person's Name: Joe Smith. First Person's Address: 1234 Main St.

First Person's Name:	First Person's Address:
Second Person's Name:	Second Person's Address:
Third Person's Name:	Third Person's Address:
Fourth Person's Name:	Forth Person's Address:
To send the form click "Send To E.S.U." Then click the Signature Block link and print it off. Send to E.S.U!

Signature Block