APPLICATION FORM. BA in Language and Culture (International Program) Faculty of Arts, Chulalongkorn University FOR ACADEMIC YEAR 2017

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1 APPLICATION FORM BA in Language and Culture (International Program) FOR ACADEMIC YEAR 2017 PLEASE USE BLOCK LETTERS. FIRST NAME: LAST NAME: FULL NAME (IN THAI): Please attach your photograph. This application form has ten pages and it is divided into six parts. Please read the instructions carefully. After completing the form, please affix your signature on the last page before submitting your application. The application deadline for our 2016 academic year is January 31, Part 1 Part II Part III Part IV Part V Part VI DOCUMENT CHECK LIST PERSONAL INFORMATION ACADEMIC PROFILE TEST SCORES LANGUAGE SKILLS AND OTHER ACHIEVEMENTS STATEMENT OF PURPOSE BALAC Application Form of 10

2 PART I DOCUMENT CHECK LIST Please tick in the box provided to ensure that you have enclosed the required documents. DOCUMENTS 1. COMPLETED APPLICATION FORM AND YOUR STATEMENT OF PURPOSE WITH YOUR AFFIXED SIGNATURE 2. COPY OF IDENTITY CARD OR PASSPORT 3. OFFICIAL HIGH SCHOOL TRANSCRIPT* 4. ORIGINAL ENGLISH PROFICIENCY TEST SCORES (TOEFL, IELTS, OR CU-TEP) 5. ORIGINAL APTITUTE TEST SCORES (OLD SAT, NEW SAT, CU-AAT, OR ACT) 6. ONE 1x1-INCH AND 2x2 INCH PHOTOS WITH YOUR NAME WRITTEN ON THE BACK (ONE 2x2 INCH OF WHICH IS AFFIXED TO THE FRONT PAGE OF THIS APPLICATION FORM) BAHT NON-REFUNDABLE APPLICATION FEE FOR APPLICANT FOR OFFICE USE *Successful applicants who have not yet finished secondary studies must submit their high school certificate or the equivalent by August 25, 2017 Otherwise they will forfeit the right to enter Chulalongkorn University. BALAC Application Form of 10

3 PART II PERSONAL INFORMATION IDENTIFICATION CARD NO. PASSPORT NO. (FOR NON-THAI APPLICANTS) PLACE OF BIRTH (CITY, COUNTRY) DATE OF BIRTH (DD/MM/YY) HOME COUNTRY NATIONALITY PERMANENT ADDRESS TELEPHONE NO. FAX NO. MOBILE MAILING ADDRESS (IF DIFFERENT FROM ABOVE) FATHER S NAME OCCUPATION/POSITION COMPANY/BUSINESS NAME TELEPHONE NO. MOBILE MOTHER S NAME OCCUPATION/POSITION COMPANY/BUSINESS NAME TELEPHONE NO. MOBILE BALAC Application Form of 10

4 PART III ACADEMIC PROFILE A. HIGH SCHOOL DETAILS HIGH SCHOOL NAME CITY/STATE/COUNTRY SCHOOL TYPE: THAI SCHOOL THAI CURRICULUM INTERNATIONAL SCHOOL AMERICAN CURRICULUM ENGLISH/BILINGUAL PROGRAM BRITISH CURRICULUM IB NEW ZEALAND AUSTRALIA OTHER, PLEASE STATE (EXPECTED) DATE OF COMPLETION CUMULATIVE GPAs FROM MATHAYOM 4-6 (OR FROM GRADE 10 TO 12) ON 4.0 SCALE OR EQUIVALENT: PLEASE INDICATE YOUR RANKING IN CLASS: TOP 5% TOP 10% TOP 20% OTHER OR N/A BALAC Application Form of 10

5 B. EDUCATIONAL HISTORY PLEASE GIVE THE NAME(S) OF OTHER SCHOOL(S) YOU HAVE ATTENDED (EXCLUDING YOUR HIGH SCHOOL DETAILS GIVEN IN SECTION A). SCHOOL NAME/COUNTRY DATES ATTENDED LEVEL BALAC Application Form of 10

6 PART IV TEST SCORES LANGUAGE PROFICIENCY TESTS: TOEFL INTERNET-BASED TOTAL SCORE: PAPER-BASED COMPUTER-BASED TOTAL SCORE: TOTAL SCORE: IELTS CU-TEP OVERALL BAND: TOTAL SCORE: APTITUDE TESTS: OLD SAT NEW SAT CU-AAT ACT CRITICAL READING SCORE: EVIDENCE-BASED READING AND WRITING: VERBAL SCORE: ENGLISH SCORE: *Please be reminded that these test results remain valid only two years after the test dates. *Please submit the original or certified copies of these test results along with this application form. BALAC Application Form of 10

7 PART V LANGUAGE SKILLS & OTHER ACHIEVEMENTS NATIVE LANGUAGE OTHER LANGUAGES AND LEVELS OF COMMAND (VERY GOOD/GOOD/FAIR) LANGUAGE(S) WRITING READING SPEAKING/LISTENING IF ADMITTED, YOUR CHOICE OF MINOR LANGUAGE SUBJECT WOULD BE (PLEASE LIST IN THE ORDER OF PREFERENCE FROM 1 TO 8): CHINESE JAPANESE FRENCH SPANISH KOREAN RUSSIAN GERMAN ITALIAN IF WE ARE UNABLE TO ACCOMMODATE YOUR TOP CHOICE OF MINOR LANGUAGE SUBJECT, WOULD YOU STILL BE INTERESTED IN STUDYING IN THIS PROGRAM? YES NO OTHER, PLEASE STATE *This year there will be a maximum of four language choices available. All languages will start at the beginner s level. BALAC Application Form of 10

8 HAVE YOU RECEIVED ANY AWARDS OR SCHOLARSHIPS? IF YES, PLEASE GIVE DETAILS. AWARDS/SCHOLARSHIPS DATES RECEIVED WHILE AT SCHOOL, HAVE YOU PARTICIPATED IN ANY EXTRACURRICULAR ACTIVITIES? IF YES, PLEASE GIVE DETAILS. EXTRACURRICULAR ACTIVITIES DATES BALAC Application Form of 10

9 PART VI STATEMENT OF PURPOSE Please write your answer in the space provided. WHY ARE YOU INTERESTED IN OUR PROGRAM? WHAT DO YOU EXPECT TO GAIN FROM OUR PROGRAM? BALAC Application Form of 10

10 I hereby certify that the information on this application is complete, accurate, and true. I agree to abide by the policies and regulations of Chulalongkorn University. I also understand that the decision by the BA in Language and Culture Program Admission Committee and/or Chulalongkorn University for admission and/or enrollment is final. Signature Date ( ) BALAC Application Form of 10

The M.A. in International Development Studies Faculty of Political Science Chulalongkorn University Bangkok, Thailand

The M.A. in International Development Studies Faculty of Political Science Chulalongkorn University Bangkok, Thailand Application form No. of Application: 1 Photo Important Type or Write in Block Capital