ENROLMENT FORM

Last Name First Name Middle Name

Civil Status Gender (x) Date of Birth (dd/mm/yyyy) Citizenship

Female Male - -
Address in Thailand (House No./Street/City/Province)

E-mail Address Religion Mobile Number LINE ID

Educational Background
Elementary

Secondary

College/
University
Course

Address (City/Province/Country)

Graduate
School
Course

Address (City/Province/Country)

ACTION / REMARKS: I understand that the down payment of 5,000

Down payment paid /
Attached scanned copy of deposit slip Baht is non-refundable upon enrollment.
APPROVED:

DR. ROBERT F. GALINDEZ

Signature over Printed Name

For the Registrar: Referred by:

Degree Program DipTEd MAEd Math MM Educ. Mgmt. EdD
BSED English MAEd Elem Science MIT PhD
MAEd ECE MAEd Admin&Supervision MBA DBA
MAEd English MAEd Guidance & Counseling
Term Academic Year
Enrolled
Documents Submitted:
Passport (Photocopy) Others (Pls. specify)
Transcript of Records (Photocopy)

Member:
St. Robert’s Group of Companies