ST1 Clinical Elective Program Application

This application form is specifically for individuals applying to elective programs. If this does not apply to you, please refer to the following options:

• Short Training Program
• ASEAN & Developing Countries Scholarship Program

These Rules and Regulations set forth the terms, conditions, and obligations applicable to all participants accepted into the Inbound Elective Study Program at the Faculty of Medicine Siriraj Hospital, Mahidol University (hereinafter referred to as the "Faculty").

All participants are required to fully comply with the provisions stipulated herein throughout the duration of their elective study. By accepting admission and signing the Declaration of Agreement, participants expressly acknowledge their understanding of, and agreement to abide by, these Rules and Regulations.

Any breach of these Rules and Regulations may result in disciplinary action, immediate termination of participation, and/or legal consequences, as deemed appropriate by the Faculty.

1. The terms “Faculty,” “Us,” or “Our” refer to the Faculty of Medicine Siriraj Hospital, Mahidol University.
2. The terms “Participant” or “You” refer to individuals, including overseas students and resident doctors, undertaking studies in the fields of medicine, health sciences, or public health within the elective program.

1. The elective study shall be strictly observational; under no circumstances shall participants engage in hands-on clinical practice, direct patient care, or any other activities beyond the permitted scope.
2. Participation in the elective program does not confer academic credit, certification of clinical competency, or employment privileges within the Faculty or any affiliated institution.
3. English Language Proficiency Requirement:
   1. Participants whose primary language is not English shall be required to provide valid proof of English language proficiency, with a minimum requirement equivalent to IELTS 6.5.
   2. The English language proficiency requirement may be waived if the applicant is a native English speaker or has completed at least one (1) academic year of full-time study in an English-medium program in one of the following countries: the United States, United Kingdom, Ireland, Australia, New Zealand, Canada (English-medium institutions only), or South Africa (English-medium institutions only).
   3. Participants from other countries, including but not limited to India, Pakistan, the Philippines, Hong Kong, and Singapore, are not exempt from this requirement.
   4. Participants who are nominated by partner institutions or through IFMSA exchange programs may submit a certified letter of English proficiency issued by their home institution in lieu of A.
4. Participants shall strictly adhere to all applicable laws, regulations, institutional policies, and ethical standards governing medical practice and patient interactions in Thailand and at the Faculty of Medicine Siriraj Hospital.
5. The Faculty reserves the unilateral right to terminate a participant’s elective study in the event of misconduct, failure to comply with regulations, or any behavior deemed inappropriate by the Faculty.
6. The Faculty shall issue an official Acceptance Letter upon confirmation of a participant’s placement. The terms and conditions specified in the Acceptance Letter shall be deemed final, binding, and non-negotiable. All other documents issued for the purpose of verifying or certifying the elective placement—whether for visa, academic, or institutional use—shall reflect and adhere strictly to the details stipulated in the Acceptance Letter.
7. The Faculty shall not endorse or acknowledge any additional documents, request forms, or agreements that contradict the conditions stipulated within these regulations. Any assertion that a participant possesses the same rights and responsibilities as regular medical students, including engagement in hands-on patient care, shall be expressly rejected.

3.1 Compliance with Thailand’s Personal Data Protection Act (PDPA)

1. The Faculty shall collect, process, and store applicant data in accordance with the Personal Data Protection Act B.E. 2562 (2019) of Thailand.
2. Personal data shall be retained for a period not exceeding three (3) years following the conclusion of the elective study, after which such data shall be securely disposed of unless otherwise required by law.
3. Participants shall possess the right to request access, rectification, or withdrawal of their personal data, subject to compliance with applicable legal frameworks and institutional policies.
4. The Faculty shall not disclose personal data to any third parties without the explicit consent of the participant, except where mandated by law or necessary for official institutional purposes.
5. The Division of International Relations may, for the purpose of promoting academic collaboration and institutional visibility, publicly share photographic images of participants through the Faculty’s official communication channels and social media platforms. Additionally, certain personal data—such as name, surname, telephone number, email address, and non-sensitive extracts of reports submitted by past participants—may be disclosed to future elective participants for the purposes of elective program orientation, peer networking, and informed decision-making regarding departmental placement. Participants who do not consent to the publication or sharing of their personal data or images under this provision may submit a written objection to any staff member of the Division of International Relations prior to or during the elective program. The Faculty shall respect such requests in accordance with the provisions of the Personal Data Protection Act B.E. 2562 (2019).

3.2 Confidentiality & Patient Data Protection

1. Participants are expressly prohibited from disclosing, recording, replicating, or transmitting any patient-related information acquired during the elective program.
2. The use of mobile phones, cameras, electronic recording devices, or cloud storage services to capture, store, or disseminate patient-related data is strictly prohibited.
3. Any breach of confidentiality shall constitute grounds for immediate termination of the elective placement and may result in civil, criminal, or disciplinary action under Thai law and Faculty policies.
4. Participants are strictly prohibited from accessing, recording, removing, duplicating, transmitting, or disseminating any form of patient-related information obtained during the elective program, whether in physical, electronic, visual, or verbal format. This prohibition includes, but is not limited to, photographs, screenshots, videos, handwritten notes, audio recordings, or digital files shared through personal devices, email, cloud storage platforms (e.g., Google Drive, Dropbox), or social media networks (e.g., Facebook, Instagram, X, LINE). All patient data shall remain strictly confidential and must not be removed from the premises of Siriraj Hospital under any circumstances. Any violation shall be considered a serious breach of institutional policy and may result in immediate termination, legal liability, and disciplinary action under applicable Thai law.

4.1 Health Protection During the Clinical Elective

1. Participants shall be personally responsible for monitoring their health and adhering to prescribed infection control measures as mandated by the Faculty.
2. The use of Personal Protective Equipment (PPE) in designated clinical environments shall be compulsory at all times.
3. Any participant experiencing symptoms indicative of an illness must immediately notify their supervising faculty member and comply with all medical guidance issued by the Faculty.

4.2 Mandatory Insurance Requirement

1. Participants must secure comprehensive medical and travel insurance coverage prior to the commencement of the elective study.
2. At a minimum, the insurance policy shall provide coverage for:
   1. Medical treatment, hospitalization, outpatient care, and accidental injury
   2. Medical evacuation and repatriation costs
   3. Loss or theft of personal belongings
3. Proof of valid insurance coverage must be submitted to the Faculty before program commencement.
4. The Faculty shall assume no liability for any medical, financial, or legal consequences arising from a participant’s failure to procure adequate insurance coverage.

4.3 Vaccination & Medical Exemptions

1. Participants must provide verifiable proof of all required vaccinations, as stipulated in the Immunization Record (ST2 Form).
2. Any participant unable to receive the required vaccinations due to medical contraindications shall bear full personal responsibility for their health and safety.
3. The Faculty shall not be held liable for any health-related complications arising from a participant’s decision not to comply with vaccination requirements, arising from a participant’s decision or failure to comply with immunization requirements, or medical advisories.

4.4 Personal Responsibility & Safety

1. Participants shall bear sole responsibility for the safekeeping of their personal belongings and valuables.
2. The Faculty shall not assume liability for any loss, theft, or damage to personal property resulting from negligence, misconduct, or security breaches.
3. Participants shall comply with all hospital security protocols and institutional safety measures.

1. Participants are solely responsible for ensuring that their visa application and entry are completed in advance of the program start date.
2. Prior to arrival, participants should verify visa requirements with the Royal Thai Consulate or Embassy, as immigration policies may be subject to change.
3. Participants must remain informed and compliant with all visa-related regulations throughout their stay in Thailand.

6.1 Compliance with Institutional Rules & Regulations

1. Participants shall adhere to all applicable faculty, ward, department, division, and hospital policies.
2. Participants must follow the directives of supervising faculty members and clinical mentors without deviation.
3. Participants shall not request changes to their assigned department, as specified in the official acceptance letter.

6.2 Professional Conduct & Ethical Obligations

1. Participants shall demonstrate professionalism, integrity, and ethical conduct in all interactions with faculty members, hospital personnel, and patients.
2. Participants shall adhere to the Faculty’s prescribed dress code, ensuring attire is professional and appropriate for clinical environments.

6.3 Attendance & Commitment

1. Full attendance (100%) at all scheduled training activities is mandatory.
2. Participants must document their daily activities in a logbook, which shall be submitted to the designated coordinator at the conclusion of the elective.
3. Submission of a completed ST9 Evaluation Form and logbook are mandatory for the issuance of a completion certificate.

1. Participants affiliated with partner institutions under MOU/MOA agreements or IFMSA shall be exempt from processing fees.
2. A non-refundable processing fee of 4,500 THB shall be payable upon arrival at the International Relations Office, via cash or credit card.

I, {name112}, hereby declare that:

1. I have carefully read, fully understood, and voluntarily agreed to be bound by the Rules and Regulations Governing Participation in the Inbound Elective Study Program at the Faculty of Medicine Siriraj Hospital, Mahidol University.
2. I acknowledge that compliance with all applicable provisions, including but not limited to institutional regulations, patient confidentiality policies, Thai laws, immigration requirements, insurance obligations, health and safety standards, and ethical conduct expectations, is mandatory.
3. I understand that any violation, misconduct, or breach of these Rules and Regulations may result in immediate disciplinary action, including but not limited to termination of my participation, withholding of certification, or legal consequences, at the sole discretion of the Faculty.
4. I confirm that the information and documentation provided in my application are accurate, complete, and truthful. I further authorize the Faculty to retain, process, and disclose my personal information for administrative purposes in accordance with Thailand’s Personal Data Protection Act B.E. 2562 (2019).
5. I acknowledge and accept that the Faculty shall not be liable for any loss, injury, or damages arising from my participation, and that I assume full personal responsibility for my actions throughout the elective period.

By signing below, I affirm my understanding of and agreement to all conditions as outlined.

Please review the available period before selecting

Please review the list of available departments before selecting