Mahidol University International College
999 Phutthamonthon 4 Road, Salaya,
Nakhonpathom, Thailand 73170
Tel +66 (0) 2441 5090 ext 3400-2
Fax +66 (0) 2441 0629
 MUIC Computer System Information Center
 Application Form
  PART 1 : PERSONAL INFORMATION
Title : Mr. Ms. Mrs.
Gender : Male Female
First Name (Eng):  
Middle Name (Eng):
Last Name (Eng):
First Name (Th):  
Last Name (Th):
Date of Birth : Age :
Marital Status: Single Married Divorced Widow
Nationality:
Citizenship:
Identification Passport ID:
Date of issue: Ex: 01/12/2009
Place of issue:
Expiry date: Ex: 01/12/2009
Disability:
Normal
Blind / Partically sighted Deaf / Hearing impairment
Mobility difficulties Disability not listed above


Permanent Address :
Address : City/Town (Moo) :
State (Building) : Street (Soi) :
District : Amphur :
Province : Zip Code :
Country :
Telephone :
Fax Number :
Mobile :
E-mail :

Mailing Address : Same as Permanent Address
Address : City/Town (Moo) :
State (Building) : Street (Soi) :
District : Amphur :
Province : Zip Code :
Country :
Telephone :
Fax Number :
Mobile :
E-mail :
  PART 2 : FINANCIAL SUPPORT (Tuition fees and living expenses)
Personal Parents
Sponsoships Scholarships
Others
  PART 3 : ACADEMIC INFORMATION
No. Degree: Major: University or College: Year Attended: GPA:
Ex.
1. (*Use for apply)
2.
3.
4.
5.
For 1st record only :

Extra activities while in university/college :

What level is yout skill of Microsoft Excel? :

Excellent Very good Average Below average

Specify computerized programs that you are specialized in :



Graduated from International Program :
No Yes

Have you taken TOEFL? :
Yes. Take on Total Score
No. Plan to take on

Have you taken IELTS? :
Yes. Take on Total Score
No. Plan to take on

*The applicant can submit the TOEFL or IELTS score after submission the application form.
  PART 4 : EMPLOYMENT INFORMATION
Begin with your most recent position; please list your full-time work history in the format below for the last three employers Current Employer :
Company : 
Industry : 
Address : City/Town (Moo) :
State (Building) : Street (Soi) :
District : Amphur :
Province : Zip Code :
Country :
Telephone :
Fax Number :
Mobile :
From :   To
Current Position : 
Reasons for taking position : 


Responsibilities : (please provide a description of your job to include the nature of work undertaken,your responsibilities, size of budget and the number of employees under your supervision, details if any clients and/or products and results attained.)


Previous Employer :

Company : 
Industry : 
Address : 
From :   To
Position : 
Responsibilities :
Reasons for leaving : 


Company : 
Industry : 
Address : 
From :   To
Current Position :  
Responsibilities :
Reasons for leaving : 
  PART 5 : DECLARATION
I apply for admission to the MBA in Business Modeling and Development. If I am offered and accept a place on the program, I undertake to abide by the rules and regulations of the university. I cartify that the information given in this application is correct and completed.
  PART 6 : LETTER OF RECOMMENDATION
Submission of two recommendations from two unrelated persons are required
- Download Recommendation Form
  7 : LOCATION
Campus : Salaya Campus (Young Talents Program)
Sathorn Campus (Talented Professionals Program)
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Mahidol University International College 999 Phutthamonthon 4 Road, Salaya,Nakhonpathom, Thailand 73170