PERSONAL INFORMATION
Title: (Mr./Ms./Mrs)
Given Name:
Middle Name: (If any)
Family Name:
Passport:	Expiry date: (DD/MM/YYYY)
Nationality:	Date of Birth: (DD/MM/YYYY)
Native language:	English	Other: Please specify
For non-native speaker of English, please specify your English test score
TOEFL: score	TOEIC: score
IELTS: score	Others: score
Allergy:
Email Address:
Phone Number:

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ACADEMIC INFORMATION
Home Institution:
Country:
Level:	Bachelor’s Degree	Master’s Degree	Doctoral Degree
Field/Program of Study:
Name of Coordinator:
Email Address:

APPLICATION FOR
Semester:	1st semester (Aug.-Dec.)
2nd semester (Jan.-May)
Summer session (Jun.-Jul.)
Begin Date: (DD/MM/YYYY)	End Date: (DD/MM/YYYY)
Type:	Semester Exchange
Non-degree
Internship
Short-term Activity: Please specify
Research: Entitled
Faculty/School at KMUTT:	Choose an item.
Field/Program of Study at KMUT:

EMERGENCY CONTACT
Name-Surname:
Relation:
E-mail address:
Phone number:	Country:

IF YOU ARE ACCEPTED TO KMUTT
1. You are going to apply for student visa at Royal Thai Embassy/Consulate in
City/State:	Country:
(See more details at http://www.thaiembassy.org/main/)
2. We shall send a Letter of Acceptance (LoA) and a supporting letter for your visa application to the following address for correspondence. (For semester exchange students, the letters will be sent to your coordinator at your home institution so please provide the coordinator’s name and your home institution address).
Name-Surname:
Address:
City/State:	Country:
Postal code:

DECLARATION: I declare that the above information is true. I understand that the University reserves the right to vary or reverse any decision regarding admission or enrolment made on the basis of incorrect information.

Applicant’s Name/Signature	Date

Checklist of requirements

No.	Document	Exchange	Non-degree	Internship	Short-term Activity	Research
1	Completed application form
2	A readable copy of passport (valid for not less than 6 months from the date of arrival in Thailand and blank pages)
3	Letter of Nomination issued by your institution
4	A copy of transcript
5	A medical certificate issued not before 1 month prior to application date
6	Learning agreement
7	English language proficiency test or Recommendation Letter (for non-native speaker of English)
8	Portfolio with explanation about your interested research area

Please submit all required application documents EITHER

By email to orginter@mail.kmutt.ac.th

OR

By mailing to

International Affairs Office

King Mongkut’s University of Technology Thonburi

126 Pracha-u-thit Road, Bangmod, Thungkru, Bangkok 10140 THAILAND

Tel: +66 2470-8342, +66 2470-8344, +66 2470-8346

Fax: +66 2470-8346