I have already attached the following required documents to complete my application:

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1 FACULTY OF GRADUATE STUDIES, MAHIDOL UNIVERSITY Phuttamonthon 4 Road, Salaya, Phuttamonthon, Nakhon Pathom 73170, THAILAND Phone: +66 (0) , (0) ext , Fax: +66 (0) gradinter@mahidol.ac.th; URL : DOCUMENTS CHECKLIST FOR APPLICANTS (please mark at each item) I have already attached the following required documents to complete my application: Completed Application Forms: comprised with Form A : Application Form Form B : Background and Proposed Field of Study Form C : Recommendation Forms (directly submitted by at least 2 referees) Two copies of Degree Certificate (with officially certified English translation) Two copies of Academic Transcript (with officially certified English translation) Two copies of Recent Photos (4.5cm x 3.5cm) Two copies of Passport Two copies of TOEFL or IELTS Two copies of Curriculum Vitae Two copies of other documents, which may be requested by each program (such as letter of work experience / professional license / concept paper) Important Note: 1. The admission process will be completed with fill-in application forms of A, B and C with all required documents as mentioned in the checklist. Particularly, Form C must be directly submitted by your referees. 2. There are two choices to submit your application documents: completed application forms with all documents to gradinter@mahidol.ac.th (.PDF format are preferred) Mail completed application forms with all documents to the following address: Students Admission Section, Faculty of Graduate Studies, Mahidol University, Phuttamonthon 4 Road, Salaya, Phuttamonthon, Nakhon Pathom, 73170, THAILAND 3. We will contact and send the formal letter of acceptation together with Form D (Certificate of Health) to you after your application has been successfully approved to our program. 4. complete the application, the non-refundable application fee of THB must be paid via credit card: Visa Master Card 5. Your application will be completed and continued once your payment has been officially verified by the bank. 6. Application with incomplete application form, documents and uncertified certificates may not be considered.

2 FORM: A APPLICATION FOR ADMISSION OF INTERNATIONAL STUDENTS INSTRUCTIONS: 1. The application should be typed if possible, or neatly handwritten in block letters. 2. Year should be written using the Anno Domini system. Proper nouns should be written in full and not abbreviated. Personal data entered in this application will only be used for admission, scholarship selection purposes, and contact information such as addresses will only be used for forming related human networks after the student returns home and for sending of information by Mahidol University. 1. ADMISSION INFORMATION I wish to apply for: Level Graduate Diploma Higher Graduate Diploma Master s degree Doctorate degree Program Code Program Name Faculty/ Institute < available at Paste a passport photo taken within the previous 6 months. First semester Second semester Academic Year 2. APPLICANT INFORMATION Write your name and nationality at the back of the photo. (4.5cm x 3.5cm) Name (Family name) (Given name) (Middle name) Title: Mr. Mrs. Miss Gender: Male Female Marital Status: Single Married Divorce Widowed Date of Birth: Date: Month: Year: Nationality: Passport No: Expiry Date : Address in Home Country: Phone: Mobile: Fax Correspondence / Current (if different from address in home country) Phone: Mobile: Fax:

3 3. EDUCATIONAL BACKGROUND Educational level Name and address of Institution Undergraduate Level Name : Year and Month of Entrance and Completion Diploma or Degree awarded / Major subject Graduate Level * If the blank spaces above are not sufficient for the information required, please attach a separate sheet. 4. EMPLOYMENT RECORD: Begin with the most recent employment, if applicable. Name and Address of Organization Period of Employment Position Responsibility / Type of work 5.ENGLISH PROFICIENCY: Evaluate your level and insert an X where appropriate in the following blank space. Excellent Good Fair Poor Reading Writing Speaking Listening 5.1. Is English your first language? Yes No 5.2. Is English the main language spoken in your home? Yes No 5.3. Were your studies at university conducted in English? Yes No 5.4. Have you taken any English proficiency test in the last 2 years Yes No (TOEFL / IELTS)? Name of the test* Test Date Earned Score: * Please add certificate of English profiency test

4 6. PROFICIENCY OF OTHER LANGUAGES Language Excellent Good Fair Poor 7. PERSON TO BE NOTIFIED IN APPLICANT S HOME COUNTRY IN CASE OF EMERGENCY Occupation: 8. PREVIOUS IMMIGRATION RECORD TO THAILAND Entry: Return: Date Purpose of visit 9. FINANCIAL RESOURCE (FOR STUDY AT MAHIDOL UNIVERSITY) Do you get support for scholarship/grant by any organization? Yes No Name of organization: Country: Contact person: Type of support: Tuition fees Research fees Monthly allowance Transportation Others (please specify detail): 10. REFERENCE PERSONS (2 persons) (1) Name in full & Title: (2) Name in full & Title:

5 11. DECLARATION I declare that to the best of my knowledge, the information I have supplied in this application and the documentation supporting it are correct and complete. I acknowledge that the provision of incorrect information or documentation relating to my application may result in cancellation of any offer of enrollment by Mahidol University. Applicant s signature: ( ) Applicant s name (in Roman block capitals) Date of application: