Signature Block

This is the final step in your second bachelors application process. Print this document from your browser, sign and date it, and mail with your $40 fee ($30 application, $10 processing) to Emporia State University, Degree Analysis, 1 Kellogg Circle, Campus Box 4026, Emporia, KS, 66801. Students should request an official transcript from each institution attended be sent directly from the institution to Emporia State University, Degree Analysis Office. We will retain your electronic application for 30 days. If the application fee and signature block are not received, then this information will be purged and you will need to re-apply. Thank you for your application to graduate study at Emporia State University.

In sending this form, I acknowledge that failure to disclose and submit official transcripts from all institutions attended and failure to disclose and submit complete and accurate information may result in the denial of admission or subsequent dismissal from Emporia State University. I certify that to the best of my knowledge statements I have made in this application are complete and true. I hereby give permissions to release appropriate test scores and academic records requested by Emporia State University. 

Signature of Applicant _______________________________________________________________

Printed Name of Applicant  ___________________________________________________________

Date  ________________________________________

Social Security Number __________________________________________________