Attach Photo
Here
APPLICATION FORM
Please rank your preferences on the option you would like to attend
____Industrial Chemistry and Management
____Material Chemistry
Personal Information
1. Name ___________________________________________________________________________________
(Last)
(First)
2. Gender
 Male
3. Date of Birth (MM/DD/YY)
_______/_______/_______
4. Country of Citizenship
_____________________
5. Place of Birth
_____________________
(Middle)
 Female
6. Permanent Mailing Address
Number and Street or Box Number_______________________________________________________________
City _____________________ State/Province _____________________ Zip/Postal Code ___________________
Country _____________________
Phone _____________________ Fax _____________________ E-mail _____________________
Educational Background
Please list below the names of those institutions (from the highest) you have attended
School
Major
Degree
Date of graduation
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Other Professional and Extracurricular Activities
1. Academic honors or awards
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
2. List any organization, community activities, or extracurricular activities.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
2
Academic Profile
1) GPA
School GPA
on a scale of
Score
Date
Remark
Score
Date
Remark
Score
Date
Remark
2) English Proficiency Test Results
Test
TOEFL
IELTS
SAT (Critical Reading)
CU-AAT (Verbal)
CU-TEP
3) Mathematics Aptitude Test Results
Test
SAT I (Mathematics)
CU-AAT (Mathematics)
4) Science Aptitude Test Results
Test
SAT Subject Tests (Chemistry)
CU-ATS - Chemistry
How did you find out about BSAC?
Newspaper______________
TV
Radio
Website ______________
Word of Mouth
Plasma Screen
Poster/Brochures______________
Others ______________________
Applicant Verification
I hereby apply for the admission to undergraduate study at Chemistry Department, Chulalongkorn University and certify that
the above information and other submitted statements are correct and complete, to the best of my knowledge. Falsification
or omission of requested information will be grounded for terminating consideration of the application, or, if after enrollment,
for canceling registration privileges.
Application’s Signature _____________________________ Date _______/_______/_______
Along with your completed application form, please enclose the following required documents.
[ ] An official transcript
[ ] Official score reports for
[ ] English Proficiency Test …………………………………….
[ ] Mathematics Aptitude Test ………………………………..
[ ] Science Aptitude Test (Chemistry) ……………………..
[ ] Two recommendation letters in sealed and signed envelopes (Overseas applicants only)
If you wish to apply in person,
please visit our BSAC office at
Room 1122, 11th Floor
Mahamakut Building
Faculty of Science, Chulalongkorn University
Tel: (+66)-2-218-7600-1
If you wish to apply by mail,
please send your application form to:
BSAC Office
Room 1122, 11th Floor
Mahamakut Building
Faculty of Science, Chulalongkorn University
Fax: (+66)-2-218-7600
E- mail: learnbsac@gmail.com
สำนักงาำนัลักงสตรนนัำนัำาำร
้ 11 อำคำนมลำมงุฎ
ล ้อา 1122 ากนั
คณะวทยำศำสรน์ จุฬำัางนณ์มลำวทยำักย
งนุาเทพฯ 10330
www.chemistry.sc.chula.ac.th/bsac