EXCHANGE STUDENT PROGRAM

APPLICATION FORM
Time: From July 16 to July 26, 2023
Venue: Ubon Ratchathani University, Thailand

1. Personal Information
Full name: …………………………………………Gender: Male Female
Passport number: ………………………………………………………………………..
Nationality:……………………………………… Ethnicity: ……………………………
Date of birth:…………………… Place of birth: ……………………………………….
Current address:……………………………………………………………………………
Year of student: ……………………… Major:……………………… Class:……………..
Tel/ Mobile:…………………………………Email:.………………………………………
2. Cumulative Grade Point Average:…………… Classification:………………..
3. Attended courses, Youth Union activities
Course/activity name Time Content Organization

4. English Proficiency
4.1. Degree and certification
Degree/Certification Training institution Place of issue Date of issue

4.2. Self-evaluation of English proficiency

Reading Listening Writing Speaking

5. Personal Statement
5.1. Introducing yourself (at least 100 words)
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5.2. Why do you choose to take part in this program and what do you expect to learn and
share from the program?(at least 200 words)
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5.3. What do you intend to introduce our University?(at least 200 words)
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…………., …/…/2023
Candidate’s signature