APPLICATION FORM

1. Personal Information

Last Name: ..................................................... 1“ passport size photo

Please attach here

* PLEASE USE BLOCK LETTERS

SEX: Female

Male

Place of Birth:

Date of Birth (D/M/Y):

Nationality: ................................................................................

Age: .....................

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...........................................................................Permanent Address: ..............................................................

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Home Telephone: ...................................................................

Mobile Phone: ..........................................................................

Fax: ................................................................................................ Email Address: ............................................................................

Citizen Identification Number:

Passport Number (for foreign students): ..............................................................................

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Bachelor of Arts in Communication Management - English ProgramFaculty of Communication Arts, Chulalongkorn University

http://www.inter.commarts.chula.ac.thTel. (Fax) (662) 0-2218-2215,(662)0-218-2216

Father’s Full Name: ................................................................. Mother’s Full Name: ....................................................................

Occupation/Position: ............................................................ Occupation/Position: ..................................................................

Office Address: ......................................................................... Office Address: ..............................................................................

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Telephone: ................................................................................. Telephone: ......................................................................................

Mobile Phone: .......................................................................... Mobile Phone: ...............................................................................

FAMILY INFORMATION

1http://www.inter.commarts.chula.ac.thEmail: commartsenglish@hotmail.com

Nick Name: ....................................................

First Name: ......................................................

Date............./............../...............

2. Education Data

High School(s) attended: YEAR NAME OF INSTITUTION ______~______ 1. ____________________________________ ______~______ 2. ____________________________________ ______~______ 3. ____________________________________

3. Test Scores

CU-AAT

Language: ............... Math: ............... Combined: ...............

Date recieved: .....................................................................

SAT I

Verbal: ............... Math: ............... Combined: ...............

Date recieved: .....................................................................

** Note: All tests must be taken less than two years prior to the application date**

ACT

Verbal: ............... Math: ............... Combined: ...............

Date recieved: .....................................................................

Other (specify)..................................................... Score: ...............

Date recieved: .....................................................................

AWARDS/CLUB YEAR RECIEVED/PARTICIPATED

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5. Faculty Interest

4. Academic Honors/Extra-curricular activities

How did you hear about our Communication Management, English program?

Booth event FriendsWebsiteOther: ______________________________

Please indicate any awards or achievements you have recieved so far (these may be sports,academic orother awards) or clubs you joined. Please attach any additional information.

http://www.inter.commarts.chula.ac.thEmail: commartsenglish@hotmail.com 2

Newspaper School counselorFamily

DOCUMENT CHECKLIST

* Please provide a checkmark on each completed document

Required DocumentsApplicant Use

Office Use

Completed application form with one-inch (1”) photo (taken no later than 6 months)

Copy of identification card or passport

Official high school transcript

Original test certificates (eg. CU-AAT, SAT, ACT, Other - specify: ..........................................................)

Original academic scores (IB, ‘A’ Level, Form 7, IGCSE, NZQA or other accredited standardized test, including the National Entrance Examination)

1,000 baht application fee

Two one inch photos (please write full name on the back)

I certify that the information on this application is complete, accurate and factuallycorrect. I agree to abide by the policies and regulations of Chulalongkorn University. I also understand that the decision made by the Bachelor Arts in CommunicationManagement committee and/or the Chulalongkorn University for admission and/orenrollment is final, and I will respect that decision.

Signature ___________________________ ( )

Date _________________________

http://www.inter.commarts.chula.ac.thEmail: commartsenglish@hotmail.com 3