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
  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 :
Citizen Identification No.: Passport No.:
Citizenship:
Place of Issue:
Issued Date:
Expiry Date:

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 : Postal Code :
Country :
Telephone : Fax Number :
Mobile : E-mail :

Correspondence Address : Same as permanent address
Address : City/Town (Moo) :
State (Building) : Street (Soi) :
District : Amphur :
Province : Postal Code :
Country :
Telephone : Fax Number :
Mobile : E-mail :
  2 : FINANCIAL SUPPORT (Tuition fees and living expenses)
Personal Parents
Sponsoships Scholarships
Others
  3. EDUCATION
Level Degree School/College Field/Branch Year Completed GPA
Ex.
High School
Bachelor's Degree
Master's Degree
Other
For 1st record only :

Extra curricular activities while in university/college :

What level is yout skill of Microsoft Excel? :

Excellent Very good Average Below average

Specify computer programs 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

  4. EMPLOYMENT

Your are currently Working Not working
Current Position : 
Responsibilities :
Company Name: 
Industry : 
Address : City/Town (Moo) :
State (Building) : Street (Soi) :
District : Amphur :
Province : Country :
Postal Code :
Telephone : Fax Number :
Mobile :
From :   To
Total Work Experience : Year(s) 


Previous Employers :

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


Company : 
Industry : 
Address : 
From :   To
Current Position :  
Responsibilities :
Reasons for leaving : 
  5 : DECLARATION
I declare that to the best of my knowledge, the information I have supplied in this application and the documentation supporting this is true, complete, and accurate. I asknowledge that the provision of incorrect information or documentation relating to my application may result in cancellation of any offer of enrollment by Mahidol University International College. I understand that the university will use this information for the purpose of admissions and to form part of a subsequent student record if I am accepted. I give my consent to the processing of my data and to use it for statistical information and reporting that will not identify me.
  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