Language Institute Chiang Mai University Application Form (Open Program)

Language Institute Chiang Mai University Application Form (Open Program)
Thank you for applying for this program.

This application is for students who would like to apply for Open Spring Program 2025

On completion of the program, students will be issued a Certificate of Attainment (Certificate) and e-transcript for each session issued by Language Institute Chiang Mai University.

There is a course which we provide:
9 - 22 February 2025

Application Deadline : 6 December 2024

If you have any questions, please feel free to email at licmuinternational@cmu.ac.th

This program will be taught entirely in English.

***Please fill out this application form in English***

Emergency Contact
Emergency Contact Name*
Relationship*
Emergency Contact Number *

DECLARATION OF DISABILITIES OR SPECIAL NEEDS
Chiang Mai University Language Institute does not discriminate based on disability in the administration of its admission policies, education policies or other administered programs. However, possibilities for reasonably accommodating participants with physical, medical, psychological, or learning disabilities may be limited. The ability of Chiang Mai University Language Institute to offer reasonable accommodation to students with disabilities or special needs on exchange is addressed on a case-by-case basis. If you have a physical, medical, psychological, or learning disability or if there are any other factors for which you may require reasonable accommodation, it is essential that you clearly state this information on the form below.
Yes, I have a physical, medical, psychological or learning disability for which I will or may require reasonable accommodations in my study abroad program.No, I do not have a physical, medical, psychological or learning disability for which I will or may require reasonable accommodations in my study abroad program.
If you answered "Yes" for above questions. Please let us know How do you anticipate your disability, or special needs will impact your participation in this program?*
Do you have any medical problems that we should know about? (If you have any concerns, please explain, including allergies or any other physical conditions. If you don't have, please can you put "No" )*
Do you have any dietary (food) restrictions that we should know about? (If you have, please can you explain. If you don't have, please can you put "No" ) *

Supplementary Information

Complete these sentences to express your real feelings. Try to complete every sentence.
1. I like.....*
2. The happiest time....*
3. At bed time...*
4. What annoys me...*
5. My greatest fear... *
6. I am best...*
7. Have you ever been abroad before? (If "Yes" where & how long?)*

Evidence of English Language proficiency (If available)

Cancelof

PARTICIPANT CONSENT

Please read carefully and follow our regulation.
I give Language Institute Chiang Mai University and its staff permission to photograph, videotape, make an audiotape of, film and/or interview myself and to publish said photographs, videotapes, audiotapes, films and/or interviews in Language Institute Chiang Mai University publications/printed material, including marketing and promotional materials, and on Language Institute Chiang Mai University’s official website. The photographs, videotapes, etc. shall constitute the exclusive property of Language Institute Chiang Mai University and may be reproduced by Language Institute Chiang Mai University and anyone it has authorized, without compensation or payment to the individual(s) concerned or any other person.
Yes, I agree to all of the terms and condition.
I understand the room and class assignment is made by Language Institute Chiang Mai University*

Yes, I understand.
If, for any reason, it is determined that the program cannot continue, I will respect and follow the decision made by Language Institute Chiang Mai University.*

Yes, I understand.
I acknowledge and agree that the program fee for this program is non-refundable once payment is made.*

Yes, I understand.
Sign your name here*
Signed Date *

DayMonthYear
Date
Should be Empty:

	Native	Advanced	Upper Intermediate	Lower Intermediate	Beginner
Speaking
Reading
Writing
Listening

Language Institute Chiang Mai University Application Form (Open Program)

Emergency Contact

DECLARATION OF DISABILITIES OR SPECIAL NEEDS

Supplementary Information

PARTICIPANT CONSENT