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KMUTT Outbound Internship Application Form

This document contains an application form for students applying for an outbound internship. The application collects personal information about the student such as name, contact details, student ID, and passport photo. It also requests information about the student's language skills, extracurricular activities, previous travel abroad, proposed internship details, parent/guardian contact information, health conditions, and includes a declaration that the student will sign verifying the truth of the information provided.

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MetasUdomwit
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143 views6 pages

KMUTT Outbound Internship Application Form

This document contains an application form for students applying for an outbound internship. The application collects personal information about the student such as name, contact details, student ID, and passport photo. It also requests information about the student's language skills, extracurricular activities, previous travel abroad, proposed internship details, parent/guardian contact information, health conditions, and includes a declaration that the student will sign verifying the truth of the information provided.

Uploaded by

MetasUdomwit
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Application Form

for Outbound Internship


Student Attach Photo

Personal Information
Studen
t ID As shown in passport

 Mr.  Miss ……………..…………….………………...


……………….……………………………........
……………………....……… First Name Family
Name Nick name

 นาย  นางสาว …………………….…………………….…….. …………………………………..…………………........


………………………………………
ชือ
่ นามสกุล ชือ
่ เล่น

Email Mobil
……………………………………….…………… e
 Male  Female Date of Birth (d/m/y)

…../..…../……. Age………. Religious………………………..…… Nationality……………….

ID. Card no ………………………………………….……. Date of Expiry

……………………….…………..

Student status  1st year  2nd year  3rd year  4th year

 Undergraduate student  Graduate student


GPA. ……………
Major in ……………………………………. Faculty/ School
…………………………………………………………………..……………………..

Current
Address…………………………………………………………………………………………………………………………………………………
….

…………………………………………………………..…………………………………………. Home
Phone…………………………………………………
International Affairs Office
6th floor, the Office of the
President Building E-mail:
Tel: 02 470-8428, 02 470-8359 [email protected]
Fax: 02 427-9860 c.th
Advisor Information

 Mr.  Miss ……………………….……………………………………………


……………………….…………………………………………
…

First Name Family Name

Email ……………………………………….…………….…………………………. Mobile

Major or Laboratory ………………………………………………………... Faculty/ School


…………………………………………………………………..

International Affairs Office


6th floor, the Office of the
President Building E-mail:
Tel: 02 470-8428, 02 470-8359 [email protected]
Fax: 02 427-9860 c.th
Language Skill
Please indicate your language skill

Language skill - Advance Intermidiat Elementary


Level e
English Speaking
English Writing
English Reading
Others
.......................................
.............

Have you completed a TOEFL, IELTS or TOEIC test in the last twelve
months?

Extracurricular activity that you ever attended in KMUTT

Dat Name of Activity Your Responsiblity in


e Activity

Have you ever been abroad?

 No.  Yes. If yes, please explain.


………………………………………………………………………………………………………………………………………………………………………………………………
…………………………
………………………………………………………………………………………………………………………………………………………………………………………………
…………………………
………………………………………………………………………………………………………………………………………………………………………………………………
…………………………
………………………………………………………………………………………………………………………………………………………………………………………………
…………………………
………………………………………………………………………………………………………………………………………………………………………………………………
…………………………
International Affairs Office
6th floor, the Office of the
President Building E-mail:
Tel: 02 470-8428, 02 470-8359 [email protected]
Fax: 02 427-9860 c.th
Proposed Internship program
Period
Ran Host University Field of Study
of
k
attenda
nce
 1st
 2n
d
 3rd

International Affairs Office


6th floor, the Office of the
President Building E-mail:
Tel: 02 470-8428, 02 470-8359 [email protected]
Fax: 02 427-9860 c.th
Parent Information

 Father’s Name……………………………………………………………………….………… Age………… Contact

Phone………………………………… Occupation…………………………………………………..…... Company

name……………………………………………………………………………………..

 Mother’s Name…………….…………………………………………………………………… Age………… Contact

Phone………………………………… Occupation…………………………………………………..…... Company

name……………………………………………………………………………………..

 Emergency Contact
Name………………………...................................................................................................
............ Age…….……

Relationship (e.g. mother, father) …………………………………..……….

Phone……………………………………………………………..……………… Mobile Phone:

……………………………….………………….……………… Email

Address………………………….……………..…………………….……..

Health
 Do you have allergies e.g. animals, food, medicines?

If Yes, please give the detail:


…………………………………………….….

 Do you have a special diet e.g. vegetarian, no beef or no pork?

If Yes, please give the detail:


…………………………………………….…..

 Do you have any ongoing medical condition? (Physical or Mental)

If Yes, please give the detail:


…………………………………………….…..

International Affairs Office


6th floor, the Office of the
President Building E-mail:
Tel: 02 470-8428, 02 470-8359 [email protected]
Fax: 02 427-9860 c.th
Declaration
I declare that the information stated in the application is true.

Signature of applicant ………………………………..…………..…..…..

Date……./…….

/……. Signature of guardian ……………………………………………………….

Date……./…….

/…….

International Affairs Office


6th floor, the Office of the
President Building E-mail:
Tel: 02 470-8428, 02 470-8359 [email protected]
Fax: 02 427-9860 c.th

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