Incoming Exchange Student Application Form

Incoming Exchange Student Application Form

Photograph

Application deadline is about 2 months before the start of each term.

Please check the updated schedule from MUIC webpage

Make sure you fill out the most current email and mailing address.

Fax the complete application form to 66 2 441 0232 and keep a copy

with you for your reference.

Send the required documents along with 2 recent photos of 1 inch. to

the International Relations Office.

It would take about 2 weeks for the office to consider your application

and issue letter of acceptance as well as letter for visa application.

After the acceptance, welcome package containing the above mentioned

letters as well as the international student guidebook will be sent to your

mailing address.

For housing reservation, please contact House Manager, Mr. Suthat Panma

at and make sure you provide your check-in date.

Required documents for the exchange inbound students are as follows:

1. an official transcript (record of completed courses and grades) from your home university;
2. a copy of passport;
3. 2 recommendation letters stating your performance while studying at your home university;
4. Housing reservation form; and
5. Airport pick-up form.

Details of Exchange Program

Home university: ______Country: ______

Degree sought at home university: ______

Degree / major sought at MUIC: ______

Duration of stay at MUIC:

1 Trimester from ______to ______

2 Trimestersfrom ______to ______

1 Academic Yearfrom ______to ______

______

Personal Information

 Mr.  Mrs.  Miss Gender:  Male  Female
Family name: ______/ Given name(s):______
Date of birth: ______Age: ______
(DD / MMM / YYYY) / Passport No: ______
Nationality: ______/ Native language: ______

Mailing Address

______
Apt. Number/ Street/ Box NumberCity or Town
______
Province/ State Country Postal Code
______
Contact Number Fax
______
Email address (Please provide us the most effective one as the International Relations Office will need to contact you via email.)

Academic Information

Contact person at home university: ______
Please provide contact details for your exchange advisor/coordinator at your home university:
______
Apt. Number/ Street/ Box NumberCity or Town
______
Province/ State Country Postal Code
______
Contact Number Fax
______
Email address

Emergency Contact (please provide an English speaking contact)

Contact person in case of emergency: ______Relationship: ______
Please provide contact details of the person mentioned above:
______
Apt. Number/ Street/ Box NumberCity or Town
______
Province/ State Country Postal Code
______
Contact Number Fax
______
Email address

Health insurance

Do you have any health problem / physical problem or have been under any medication?
______
Do you plan to apply for any health insurance? If so, please provide us the detail of the company.
______
Apt. Number/ Street/ Box NumberCity or Town
______
Province/ State Country Postal Code
______
Contact Number Fax

Visa Application

Which Royal Thai Embassy or Consulate you are going to apply for student visa?
______
______
Apt. Number/ Street/ Box NumberCity or Town
______
Province/ State Country Postal Code

Course List (for the whole period of your study at MUIC)

HomeUniversity / MahidolUniversityInternationalCollege
Code / Title / Credits / Code / Title / Credits

Declaration

I hereby declare that during the period of my studies at MUIC, I will follow the rules, policies, and code of student conduct accordingly. I further understand that all my personal information is confidential and used only in the capacity intended by MUIC.

Applicant signature: Date:

Staff Only

Placement test required:  English Mathematics Date of placement test:

Received by: Date:

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