Application form: Inbound Exchange student

Full Name (please enter your name according to passport)*

First NameMiddle NameLast Name

Semester of exchange application

Preferred exchange period

Specify exchange period (If different from the list above)

Proposed field of study

Proposed field of study for the exchange period

Proposed field of study (If not listed in the drop box above)

CIEL shall attempt to coordinate the request (Acceptance is subject to Faculty's discretion)

Please describe your motivations to participate in exchange program at Rangsit University. (No entry limit)*

Proposed study plan

Interests / Hobbies

E-mail (A)*

Phone Number (A)

Country codeArea code + Phone number

Facebook (if any) (A)

Address (A)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Birth Date (A)*

DayMonthYear

Birth Date (A)*

Date

Gender*

Country of Citizenship*

Passport number*

Scan of Passport*

Upload a File

Visa submission place (please select country and city)*

Major Field of study*

Faculty*

Year of study*

Current Grade point average

Is English your first language?

If "No" please provide information on your English language proficiency*

	Very good	Good	Fair	Poor
Speaking
Listening
Reading
Writing

English language proficiency test score (if available)

Transcript / Study record*

Upload a File

Upload scan of original transcript / study record issued by Registrar office of the home institution

Reference form*

Upload a File

Full Name (E)*

PrefixFirst NameMiddle NameLast Name

Relationship*

E-mail*

Phone Number (E)*

Country codePhone Number

Address (E)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home university / institution

Specify home institution if not listed above

Name of Exchange Coordinator or Authorized Person

PrefixFirst NameMiddle NameLast Name

Title

Faculty / Office

E-mail (H)

Phone Number (H)

Country codePhone Number

Address (H)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Nomination form*

Upload a File

Please download institutional nomination form signed and sealed by authorized person at the home institution

D1: Any disabilities and/or medical condition that RSU CIEL should be aware of?

YesNo

If "Yes" (D1), please explain

D2: Have you ever been convicted of a criminal crime offense?

YesNo

If "Yes" (D2), please explain

3: Do you foresee any other difficulty that may affect the completion of your exchange period?

YesNo

If "Yes" (D3), please explain

Health certificate or exemption form

Upload a File

Please download institutional health certification form signed and sealed by authorized person at the home institution

CHECKLIST

Have you uploaded the scanned of the following documents;

: : passport

: : transcript / study record

: : nomination form signed by the authorized person with institutional stamp

: : reference form

: : health certificate or health certificate exemption form

**This application will not be processed unless it is complete and is accompanied by the above listed documents.

APPLICANT'S DECLARATION

By submitting this online 'RSU CIEL: International Exchange application form', I certify that I am the applicant named in this form. All information in this form, and documents provided for this application, are true and correct. I understand that if I have provided false or misleading information it may result in a decision not to accept me to participate in the Program, or, if already accepted, may lead to my dismissal. I fully understand if I am to join the program, I agree to;

1. follow the courses of study and abide by the rules and regulatins of Rangsit Universityand the law of Thailand;

2. act in such a manner that I will not bring disrepute to myself, Rangsit University, home institution or my country of citizenship during RSU CIEL: Exchange program;

3. abide by the rules and regulations governing my visa;

4. release information contained in this application form to relevant authorities and for RSU CIEL exchange student yearbook/semesterbook publication;

5. be responsible for any study materials, personal and medical expenses that shall incur during my exchange period at Rangsit University;

6. obtain full international travel and health insurance prior to the departure to Thailand;

7. the use of photographs of myself taken by RSU CIEL, Rangsit University - the likely uses include promotional materials, brochures, displays, expos, posters, cards, newspaper article, website, communication with eductional agents and advertising.

8. the terms and agreements as per the Memorandum of understanding established in regard to exchange activtity between my home institution and Rangsit University

9. liability waiver (available at CIEL's web site)

*Typing your name on the signature line constitutes an electronic signature.*

SIGNATURE (Type your full name)

Date and time of submission

MonthDayYearHourMinutesAM/PM Option

International student exchange application form

Section A: Applicant details

Academic information

Section B: Emergency contact

Section C: Home Institutional information

Section D: Medical and further information