International Relations Office, Division of Public Relations and Foreign Affairs,

International Relations Office, Division of Public Relations and Foreign Affairs,

Mahasarakham University, Khamriang Sub-District, Kantarawichai District,

Maha Sarakham 44150 Tel/Fax: [phone]

Affix picture here MSU GLOBAL LEADERSHIP CAMP APPLICATION FORM
Student Personal Information
Applicant Name: (ENGLISH) (Same as In Passport) (First) (Middle) (Last)
Nationality:
Mailing address:	Gender: £ Male £ Female
Contact Number:	G.P.A:
E-Mail:	Graudation Year:
Adviser E-mail Home Institution:	Home Country:
Adviser:	:
Passport No:	Country of Issue:
English Language Test Taken		Language Proficiency Level
Health Conditions
Allergies:
Major Medical Problems (please specific)
Medications currently taken (please specify)
Other
Guardian/Parent Contact Information
First Name	Mr./Ms./Mrs.
Last Name
Address
Telephone Number (Emergency)
Email Address
Relationship with the applicant
Checklist
Please scan and send all the required documents listed below to: [e-mail] by June 15^th, 2015
Materials	£ Application form £ Approval of the home university £ Scholarship Essay Form £ Others
Declaration
I hereby declare that the information provided in this application is true and complete in every detail. I authorize Mahasarakham University to handle and use my personal data/information for the purposes of the program.
Signature______________________________________________	Date: _______________________
Scholarship Essay Form

Complete applications may be mailed, faxed, or e-mailed directly to:

	Tharnthip Kaeothachat (Ms.) International Relations Officer International Relations Office Mahasarakham University Khamriang Sub-district, Kantarawichai District Maha Sarakham 44150 Thailand Tel/Fax: [phone] E-mail: [e-mail]

Дата добавления: 2015-08-27