APPLICATION FORM

BA in Language and Culture (International Program)

Faculty of Arts, Chulalongkorn University
FOR ACADEMIC YEAR 2014

PLEASE USE BLOCK LETTERS.

FIRST NAME: _________________________________
LAST NAME: _________________________________

Please attach your

photograph.

FULL NAME (IN THAI): _________________________

This application form has ten pages and it is divided into six parts. Please
read the instructions carefully. After completing the form, please affix
your signature on the last page before submitting your application. The
application deadline for our 2014 academic year is January 31, 2014.

Part 1

DOCUMENT CHECK LIST

Part II

PERSONAL INFORMATION

Part III

ACADEMIC PROFILE

Part IV

TEST SCORES

Part V
Part VI

LANGUAGE SKILLS AND OTHER ACHIEVEMENTS

STATEMENT OF PURPOSE

BALAC Application Form 2014

Faculty of Arts, Chulalongkorn University

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PART I

DOCUMENT CHECK LIST

Please tick in the box provided to ensure that you have enclosed the
required documents.
DOCUMENTS

FOR
APPLICANT

FOR
OFFICE USE

1. COMPLETED APPLICATION
FORM AND YOUR STATEMENT
OF PURPOSE WITH YOUR
AFFIXED SIGNATURE
2. COPY OF IDENTITY CARD OR
PASSPORT
3. OFFICIAL HIGH SCHOOL
TRANSCRIPT*
4. ORIGINAL (OR CERTIFIED
COPIES OF) ENGLISH
PROFICIENCY TEST SCORES
(TOEFL, IELTS, OR CU-TEP)
5. ORIGINAL (OR CERTIFIED
COPIES OF) APTITUTE TEST
SCORES (SAT I, CU-AAT, OR
ACT)
6. TWO ONE-INCH PHOTOS WITH
YOUR NAME WRITTEN ON THE
BACK (ONE OF WHICH IS
AFFIXED TO THE FRONT PAGE
OF THIS APPLICATION FORM)
7. 1000 BAHT NON-REFUNDABLE
APPLICATION FEE

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Faculty of Arts, Chulalongkorn University

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*Successful applicants who have not yet finished their high school must
submit their high school certificate or the equivalent by August 8, 2014.
Otherwise they will lose the right of being a Chulalongkorn University
student.

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Faculty of Arts, Chulalongkorn University

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PART II

PERSONAL INFORMATION

IDENTIFICATION CARD NO. ____________________________________________

PASSPORT NO. (FOR NON-THAI APPLICANTS) ______________________________
PLACE OF BIRTH (CITY, COUNTRY) ______________________________________
DATE OF BIRTH (DD/MM/YY) ____________________________________________
HOME COUNTRY ___________________________NATIONALITY _____________
PERMANENT ADDRESS _________________________________________________
____________________________________________________________________
____________________________________________________________________
TELEPHONE NO. _______________________ FAX NO. ______________________
EMAIL ________________________________ MOBILE _______________________
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
____________________________
____________________________________________________________________
____________________________________________________________________

FATHERS NAME ______________________________________________________

OCCUPATION/POSITION _______________________________________________
TELEPHONE NO. ______________________ MOBILE ________________________
MOTHERS NAME
____________________________________________________________________
OCCUPATION/POSITION _______________________________________________
TELEPHONE NO. _______________________________ MOBILE _______________

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Faculty of Arts, Chulalongkorn University

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PART III

ACADEMIC PROFILE
A. HIGH SCHOOL DETAILS

HIGH SCHOOL NAME _________________________________________________

CITY/STATE/COUNTRY ________________________________________________
SCHOOL TYPE:
THAI SCHOOL

INTERNATIONAL SCHOOL

THAI CURRICULUM

AMERICAN CURRICULUM

ENGLISH/BILINGUAL PROGRAM

BRITISH CURRICULUM
IB
NEW ZEALAND
AUSTRALIA
OTHER, PLEASE STATE
_____________________

(EXPECTED) DATE OF COMPLETION ______________________________________

CUMULATIVE GPAs FROM MATHAYOM 4 -6 (OR FROM GRADE 10 TO 12) ON
4.0 SCALE OR EQUIVALENT: _____________
PLEASE INDICATE YOUR RANKING IN CLASS:
TOP 5%

TOP 10%

BALAC Application Form 2014

Faculty of Arts, Chulalongkorn University

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OTHER OR N/A

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B. EDUCATIONAL HISTORY
PLEASE GIVE THE NAME(S) OF SCHOOL(S) YOU HAVE ATTENDED
(EXCLUDING YOUR HIGH SCHOOL DETAILS IN SECTION A).
SCHOOL NAME/COUNTRY

DATES ATTENDED

LEVEL

_________________________

_____________ __ ____________

_________________________

_____________ __ ____________

_________________________

_____________ __ ____________

_________________________

_____________ __ ____________

_________________________

_____________ __ ____________

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Faculty of Arts, Chulalongkorn University

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PART IV

TEST SCORES

LANGUAGE PROFICIENCY TESTS:

TOEFL

INTERNET-BASED

TOTAL SCORE: _______

PAPER-BASED

TOTAL SCORE: _______

COMPUTER-BASED

TOTAL SCORE: _______

IELTS

OVERALL BAND: _______

CU-TEP

TOTAL SCORE: _______

APTITUDE TESTS:
SAT

CRITICAL READING SCORE: _______

CU-AAT

VERBAL SCORE: _______

ACT

ENGLISH SCORE: _______

*Please be reminded that these test results remain valid only two years
after the test dates.
*Please submit the original or certified copies of these test results along
with this application form.

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Faculty of Arts, Chulalongkorn University

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PART V
OTHER

LANGUAGE SKILLS &

ACHIEVEMENTS

NATIVE LANGUAGE _______________________

OTHER LANGUAGES AND LEVELS OF COMMAND (VERY GOOD/GOOD/FAIR)

LANGUAGE(S)
SPEAKING/LISTENING

WRITING

READING

1.

____________

_________

________ ___________

2.

____________

_________

________ ___________

3.

____________

_________

________ ___________

4.

____________

_________

________ ___________

IF ADMITTED, YOUR CHOICE OF MINOR LANGUAGE SUBJECT WOULD BE

(PLEASE LIST IN THE ORDER OF PREFERENCE FROM 1 TO 6):
CHINESE ___
KOREAN ___

JAPANESE ___
RUSSIAN ____

GERMAN ___

FRENCH ___

SPANISH ____

ITALIAN ____

IF WE ARE UNABLE TO ACCOMMODATE YOUR TOP CHOICE OF MINOR

LANGUAGE SUBJECT, WOULD YOU STILL BE INTERESTED IN STUDYING IN
THIS PROGRAM?
YES
NO
____________________

OTHER, PLEASE STATE

*This year there will be a maximum of four language choices available. All
languages will start at the beginners level.

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Faculty of Arts, Chulalongkorn University

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HAVE YOU RECEIVED ANY AWARDS OR SCHOLARSHIPS? IF YES, PLEASE

GIVE DETAILS.
AWARDS/SCHOLARSHIPS
RECEIVED

DATES

_______________________________ __________________
_______________________________ __________________
_______________________________ __________________
_______________________________ __________________
WHILE AT SCHOOL, HAVE YOU PARTICIPATED IN ANY EXTRACURRICULAR
ACTIVITIES? IF YES, PLEASE GIVE DETAILS.
EXTRACURRICULAR ACTIVITIES

DATES

_______________________________ __________________
_______________________________ __________________
_______________________________ __________________
_______________________________ __________________

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Faculty of Arts, Chulalongkorn University

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PART VI

STATEMENT OF PURPOSE

Please write your answer in the space provided.

WHY ARE YOU INTERESTED IN OUR PROGRAM? WHAT DO YOU EXPECT TO
GAIN FROM OUR PROGRAM?

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Faculty of Arts, Chulalongkorn University

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______________________________________________________
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I hereby certify that the information on this application is
complete, accurate, and true. I agree to abide by the policies and
regulations of Chulalongkorn University.
I also
understand that the decision by the BA in Language and Culture
Program Admission Committee and/or Chulalongkorn University
for admission and/or enrollment is final.
Signature

_____________________________ Date ____________________

(
BALAC Application Form 2014
Faculty of Arts, Chulalongkorn University

)
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