Faculty of Economics, Chulalongkorn University
Outgoing Exchange Program Academic Year ______
Paste
photo
here
The application form should be completed in block letters.
นาย/นางสาว
(ภาษาไทย)________________________________________________
_____________
ชื่อ-นามสกุล (ตัวบรรจง)
Mr. /Ms. (English)
_________________________________________________________
________
First name-Family name (in block letters)
 Email
Address:___________________________________
Student ID
Telephone:
Home_________________________
Mobile_______________________________
Name of guardian____________________________Guardian’s
contact number: __________
1
GPAX:__________ Current year of study___________ Program
 EBA
 BECON
Expected exchange semester  First semester (August December)
 Second semester (January - May)
Preferred host institutions:
Host institution choice #1:
______________________________________________________
Host institution choice #2:
______________________________________________________
Host institution choice #3:
______________________________________________________
Nb. Please list your choice in order of preference. Although we will try to
accommodate your request, we cannot promise placement at your preferred host
institution.
English language proficiency:
Excellent
Good
Fair
Poor
Speaking
Listening
Writing
Reading
2
Other language(s)proficiency:
____________________________________________________
English language proficiency test:
 TOEFL ( PBT,  CBT,  IBT)
Score______
Test date______
Score______
IELTS
Test
date______
 Others, please specify______________________
Score______
Test date______
If studying abroad would delay your graduation, would you still
be interested?
 Yes
 No
Do you wish to transfer credits earned and have them counted
toward your degree at Chulalongkorn University?
 Yes
 No
3
Supporting documents
Official transcript
 1 photograph (1
inch)
English language proficiency test score report
Copy
of passport
Statement of purpose cum self-assessment of ambassadorial
qualities
 Others, please specify________________________
Applicant
Guardian
Signature __________________________
Signature
__________________________
(__________________________)
(__________________________)
______ / ________ / ________
______ / ________ /
________
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