Paperclip four Please enclose (4) photos to four recent your completed application. 2 x 2 photos Pridi Banomyong International College Thammasat University, Bangkok Thailand Application Form for Thai Studies Program (For Non-Exchange) OFFICE USE ONLY: Duration: X Summer (June-July) Semester 1 (August-December) Semester 2 (January-May) 1) Follow all the instructions listed on this sample application. 2) Print and complete application, using this sample as a guide. 3) Sign Application and datedeadline: the application. Application received (date): 4) Paperclip four (4) passport size photos to the application. April 30 5) Submit the application to UCEAP. You may also want to keep a June 30 Application No. copy for your own records. November 30 CLICK HERE FOR PBIC APPLICATION PERSONAL INFORMATION First Name: Family Name: Personal information must match your passport. Date of Birth: Place of Birth: Gender: Citizenship: Male Female Should be country that issued your passport. Passport No. Passport info must match your passport. Expiry Date: Day: Month: Year: Visa No. Expiry Date: Day: Month: Year: Leave blank. You do not have a visa yet... (ESTIMATE) Day: 20 Month: 06 Year: 2012 Anticipated date of arrival in Thailand: Day:. Month: Year: Correspondence Address: Your current mailing address. Mobile Your current contact information. E-mail: Be sure to check your e-mail on a regular basis for important messages from Thammasat and UCEAP. Permanent Address: Your permanent or parental address. Page 1 of 5
Mobile E-mail: Emergency Contact Person: Should be the same person listed on your UCEAP application. Name: Relationship:.. Address: Mobile E-mail: ACADEMIC INFORMATION Degree/Diploma of your current study: X Bachelor Master Doctorate Other Home Institution (if any): Major: University of California, (campus) Your UC major. Expected Date of Graduation: Anticipated UC graduation date. Cumulative GPA: Your UC GPA. LANGUAGE PROFICIENCY TOEFL Score.. (Date received: Day: Month: Year: ) English IELTS Score.... (Date received: Day: Month: Year: ) A recommendation letter from your English teacher Native speaker. X Other (please specify)... Please mark in the blank. As applicable. Skills Thai Good Fair None Listening Speaking Reading Writing *Academic transcripts and language test results may be either originals or copies.* Page 2 of 5
4. DURATION OF YOUR STUDY Applying for: Semester 1 : August - December Semester 2 : January - May Both Semester 1 and 2 X Summer : June July Coursework is set for the summer program. All summer students will be 5. COURSE SELECTION taking the same three courses. List accordingly. Code Summer Program (June July) Course PD 343 Thai Society and Culture PD 353 Buddhism in Thailand PD 100 Beginning Thai Semester 1 (August - December) 4. 5. 6. Semester 2 (January - May) 4. 5. 6. 6. FINANCIAL SUPPORT Please indicate the source(s) of financial support during your proposed period of study: As applicable. Parents Scholarship Personal funds Other. 7. STATEMENT OF PURPOSE (This section can be submitted on a separate paper) You are required to submit a 500 word statement of purpose. You can write it on this form or attach it as a separate page. Some topics you may want to address: 1) Why do you want to study abroad in Thailand and at Thammasat University? 2) What are your academic/career goals and how does study abroad fit it? 3) What do you hope to gain by studying abroad? Page 3 of 5
8. CHECKLIST OF REQUIRED ACCOMPANYING DOCUMENTS X Official academic transcript (must be in English or with accompanying translation) X A copy of passport Letter of recommendation from academic institution or employer X Four recent 2 X 2 photographs Documents of English competency X Health insurance Document of Thai competency (if applicable) Financial statement Resume or CV X Forms signed and dated Other... Page 4 of 5
9. DECLARATION AND SIGNATURE I declare that the information supplied by me on this form is complete, true and correct in every particular. I authorize any other person or body to supply information to Pridi Banomyong International College, Thammasat University regarding this application. Applicant: Signature... Sign and print your name. (Print Name..) Date Date. When completed, this form should be returned to either: Mailing Address: Email: Important! not sendcollege, supporting documents University. All materials Pridi BanomyongDo International Thammasat Universitydirectly to Thammasat pbic@tu.ac.th should be sent to UCEAP. As soon as your application is complete with all required documents, it will be forwarded Thammasat for consideration. thaistudies.pbic@gmail.com Anekprasong 3 Building, to No.2 Prachan Road,University Bangkok 10200 Thailand Page of 5 Updated: February 29, 5 2012