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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
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$ 29,700 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 $7,500.
List the amount that you will have available for your first year of study at Emporia State University. US$______________________
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




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)



Required items in addition to this application:



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

 1 Kellogg Circle, ESU Box 4041

Emporia, Kansas 66801-5415 

Telephone: (620)341-5374               
Fax: (620)341-5918               
Web Page: