ESLI Online Application for Admission

To apply for ESLI, please complete this form along with the Statement of Financial Guarantee form and the Financial Certification form for your application packet to be complete.





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We will be using this email address for all communication pertaining to your ESLI application


Previous Education


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If Yes, you will need to complete a certificate of Immunization form.


Information for Visa




Please provide a passport size recent picture of the applicant. We will not be able to proceed with the application without it.



Name of Institution




By typing my name in capital letters, I attest that all the information that I have supplied is true to the best of my knowledge and that any omission or misrepresentation will invalidate any further consideration of subsequent admission to the English as a Second Language Institute (ESLI). I also understand that admission to the English as a Second Language Institute does not constitute admission to undergraduate or graduate degree programs of Jackson State University.

U.S. Immigration law requires that the application form be signed by the prospective student.


Please enter MM/DD/YYYY format

Please enter the Name, Telephone Number, Address (Number, Street, City, State and Country) of the Contact Person in case of Emergency.