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Summer Program Application-Form

The document is an application form for Mahidol University's summer program in Thailand. It requests information such as personal details, education background, language proficiency, emergency contacts, and a statement of intent. Applicants must indicate their preferred module of study, submit required documents by the deadline, and make a payment of $1,500 by a certain date. Bank details are provided for payment.

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Hilmy Yafi Zuhair
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40 views3 pages

Summer Program Application-Form

The document is an application form for Mahidol University's summer program in Thailand. It requests information such as personal details, education background, language proficiency, emergency contacts, and a statement of intent. Applicants must indicate their preferred module of study, submit required documents by the deadline, and make a payment of $1,500 by a certain date. Bank details are provided for payment.

Uploaded by

Hilmy Yafi Zuhair
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MAHIDOL UNIVERSITY

SUMMER PROGRAM – SAWASDEE THAILAND


APPLICATION FORM

Please indicate below the interested module


HOW TO APPLY : □ Culture
Please complete all sections of this form and submit it with other required □ Business
documents to International Relations Division, Mahidol University via
<[email protected]> by 15 May 2018 □ Environment
□ Technology

PERSONAL INFORMATION

Given Name: ___________________________ Family Name: _______________________________

Calling Name: ___________________________ Gender : □ Male □ Female Photo


Date of Birth: ______________________ (dd/mm/yyyy) Nationality: ______________________

Religion: _______________________________ Blood Type: ____________________________

Passport Number : _______________________ Telephone : _____________________________

Mailing Address :___________________________________________________________________________________

_________________________________________________________________________________________________

Email: _______________________________________ Facebook: ___________________________________________

Food Restrictions / Food Allergies :_____________________________________________________________________

EDUCATIONAL INFORMATION

1. Academic Background :

Faculty / Department : _______________________________________________________________________________

Year of study (as of May 2018) : ____________________ Major : __________________________________________

University: __________________________________________________ Country : ______________________________

University Address: _________________________________________________________________________________

2. Language Proficiency :

English Communication □ Excellent □ Good □ Fair □ Poor

Other Language 1 □ Excellent □ Good □ Fair □ Poor

Other Language 2 □ Excellent □ Good □ Fair □ Poor


MAHIDOL UNIVERSITY
SUMMER PROGRAM – SAWASDEE THAILAND
APPLICATION FORM

EMERGENCY CONTACT PERSON

Name___________________________________________________ Relationship_______________________________

Contact Address____________________________________________________________________________________

Contact Number____________________________________________________________________________________

STATEMENT OF INTENT

1. Why are you interested in this program ?

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

2. What do you expect to learn from this program?

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

3. Please specify if you have any special request.

- Dietary requirement:__________________________________________________________________________

- Allergy: ____________________________________________________________________________________

REQUIRED DOCUMENTS CHECKLIST

□ Application Form □ Curriculum Vitae / Resume □ A copy of passport


□ Transcript □ A copy of the pay-in slip (by 30 May 2018)
MAHIDOL UNIVERSITY
SUMMER PROGRAM – SAWASDEE THAILAND
APPLICATION FORM

DECLARATION

I declare that the information on this application is complete and correct. I will provide original documentation as required and
acknowledge that the provision of incorrect information or documentation or the withholding of relevant information or
documentation relating to this application may result in cancellation of any arrangement by Mahidol University.

Applicant’s Signature_______________________________________

Date_______________________________________

Remarks: All applicants are requested to make the payment (USD 1,500 for participation) . Please also send a copy of the
pay-in slip to the International Relations Division, Mahidol University <[email protected]> by 30 May 2018 at the latest.

Bank Details

A/C Name: IR Special Projects

Bank Name: Siam Commercial Bank (SCB)

Branch: Mahidol University, Salaya

Bank A/C: 333 - 271161 - 8

For more information

International Relations Division

Mahidol University

Tel: +66 2 849 6232 Fax: + 66 2 849 6237


Email: [email protected]

Facebook: http://www.facebook.com/International.Relations.Mahidol

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