Chulalongkorn University

Attach Photo
Visiting/Free Mover Student Here
Application Form
(Non-degree)

Information must be typed.

PERSONAL PROFILE
Mr./Miss/Mrs./Other _______________________________________________________________________
First Name Middle Name Last Name

Name Pronunciation ____________________________________________________________

Sex  Male  Female Date of Birth _____/________/______
Day Month Year
Nationality ______________________________Passport Number______________________________

Current Address _____________________________________________________________________

Street City
__________________________________________________ Tel: _______________________________
State Zip Code Country

Fax: _____________________________ E-Mail: _____________________________________________

Proposed field of study:  Bachelor  Master  Ph.D.

Major: __________________________________ Faculty: __________________________________

Details of all programs: http://www.academic.chula.ac.th/search/search.asp

Details of all international programs:
http://www.inter.chula.ac.th/inter/internationalstudents/InterProgram2015.pdf

Semester in which you Before choosing appropriate semester system below, applicants must read the
wish to enroll: academic calendar
(http://www.inter.chula.ac.th/inter/exchangestudent/ExchangeInbound.htm)

Semester System Trimester System

 First (Aug-Dec)  First (Aug-Nov)
 Second (Jan-May)  Second (Dec-Mar)
 Summer (Jun-Jul)  Third (Apr-Aug)
Academic Year _______ Academic Year _______

 Trimester System is used for only some international graduate programs.

Proposed Grading System:

 Standard grading system with A, B, C, D and F

 Grading with “S” for Satisfactory or “U” for Unsatisfactory (with examination)
 Grading with “V” for Visitor or “W” for withdrawn (without examination)

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EDUCATIONAL INFORMATION

Home University _________________________________________ Country ___________________

Educational Background

Institution Location Major/Field of study Period of attendance Degree obtained

______________________ _______________ ____________________ ________________ ____________

______________________ _______________ ____________________ ________________ ____________

______________________ _______________ ____________________ ________________ ____________

______________________ _______________ ____________________ ________________ ____________

______________________ _______________ ____________________ ________________ ____________

English Proficiency: (for non-native speaker)

(a) Have you completed a TOEFL test or equivalent in the last twelve month?
 Yes, score:_____________________  No

(b) Do you intend to sit for a TOEFL test or equivalent in the immediate future?
 Yes  No

If yes, please provide details of test and date.______________________________________________

(c) Indicate your English proficiency

Excellent Good Fair Poor
Reading    
Writing    
Speaking    
Listening    

Thai Proficiency:
(a) Indicate your Thai proficiency
Excellent Good Fair Poor
Reading    
Writing    
Speaking    
Listening    

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Study Plan: (Please use a separate sheet if necessary.)

Faculty: __________________________________________________

Major: ___________________________________________________

_________________________________________________________________________________________

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Please check that you have enclosed all the relevant documents with your application:

 A completed application form

 A nomination letter from home institute
 2 references in signed and sealed envelopes
 An official transcript of academic records (to be issued by the institute presently being attended)
 An English proficiency score record (for non-native speaker of English)*
 A copy of passport
 Study plan / description of academic interests (on a separate sheet of A4-sized paper)
 Eight 1-inch-colored photos (with blue background) taken no more than six months in polite attire or
a civil servant’s uniform, signed on the reverse side, one of which should be attached to the
application form

* It is required for the exchange student who would like to study in International Program.

Send all application documents to

Director
Office of International Affairs and Global Network
Chamchuri 1 Building, 1st Floor,
Chulalongkorn University
Phyathai Road, Pathumwan
Bangkok 10330
THAILAND
Tel: +662 218 3335
Fax: +662 216 1299
Email: int.off@chula.ac.th

STUDENT’S SIGNATURE

I hereby apply for admission to study at Chulalongkorn University and I confirm that the information
provided above is correct to the best of my knowledge.

Signature _________________________________________________ Date ___________________________

HOME INSTITUTION APPROVAL

I certify that the above student has been approved for participation in the exchange program for the
following periods:
From (Semester, year) ________________________ To ________________________

Signature of Exchange Coordinator

________________________________________________

(_______________________________________________)

Date ________________________

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