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Application Number
Photograph
Bachelor of Art Program in Language for Careers (International Program)
Department of Linguistics, Faculty of Humanities
SRINAKHARINWIROT UNIVERSITY
APPLICATION FORM
PLEASE USE BLACK BALLPOINT OR TYPE IN BLOCK LETTERS
1. PERSONAL INFORMATION
Family name :
First name :
Title :
Identification Number/
Passport Number
Gender :
Date of Birth: (day/month/year)
/
Male
Nationality
/
Age (until 3 March 2015)
Female
Years
Months
Religion
Days
Permanent address
Correspondence address (If different from above)
Contact numbers
Home Phone :
Email :
Mobile :
7
alT11111,111Y11S+14@@TTITI iin-ainyi 2558
2. ACADEMIC BACKGROUND
Academic institutions attended since age of 16 and qualifications obtained or entered for
Qualifications
Dates of
Qualifications awarded and
Institution (SchooVCollege/
expected
attendance
grades/class of Honors
Other Higher Education)
(given date)
(Month/Year)
3. ENGLISH LANGUAGE COMPETENCE
Please fill in the information of English Language Competence you have already obtained.
TOEFL
/ Other •
/IELTS :
Date of Examination Day
Month
Year
Date of Test Report : Day
Month
Year
4. GUARDIAN INFORMATION
0 FATHER
❑ MOTHER
Family name :
First name :
Title :
Age :
Nationality :
Occupation :
Permanent address
Correspondence address (If different from above)
Contact numbers
Home Phone :
Email :
❑ OTHER
Mobile :
Monthly income :
•
8
vineTouTriFi
01TTIV1.1191111,iNEM°7111 `llf11501f1W1 2558
5. CHECKLIST
Please check whether you have enclosed the following documents with your application. All
copied documents must be signed and verified by the applicant.
For Thai Applicants :
❑
1. A certified true copy of academic record
❑
2. Statement of Purpose
❑
3. A certified true copy of application fee receipt
❑
4. A certified true copy of ID card
❑
5. A certified true copy of resident registration
❑
6. Two 1-inch recent photographs
❑
7. Certified copies of English Language Competence (optional)
❑
8. Certified copies of SAT (optional)
❑
9. A financial statement issued by bank or financial institute
❑
10. A certified true copy of change of names/last names (if any)
Others
For Non-Thai Applicants :
❑
1. A certified true copy of academic record
❑
2. Statement of Purpose
❑
3. A certified true copy of application fee receipt
0
4. A certified true copy of passport
❑
5. A certified true copy of resident registration
❑
6. Two 1-inch recent photographs
❑
7. Certified copies of English Language Competence (optional)
❑
8. Certified copies of SAT (optional)
❑
9. A financial statement issued by bank or financial institute
❑
10. A certified true copy of change of names/last names (if any)
❑
11. Others
Note: 1) Applicants not supplying an English Language Competence scores will be required to take English
Entrance Examination.
2) Applicants not supplying SAT will be required to take SWUSAT.
DECLARATION: I confirm that the information given on this form is true, complete and accurate and no
information requested or other material information has been omitted. I have read the guide for
completing the application. I undertake to be bound by the terms set out in it and I give my consent to
the processing of my data by Srinakharinwirot University. I accept that, if I do not fully comply with these
requirements, the university shall have the right to cancel my application and I shall have no claim against
the university.
Applicant's signature
Date