Boromrajonani College of Nursing Nopparat Vajira
Attach photograph
Student Exchange Application Form
Part A: Personal Information Name
Mr./Ms…………………………………………………………………………
นาย/นางสาว............................................................................................................................. Date of Birth (dd/mm/yyyy)……………………Age………………………… ID Card No…………………Expire Date (dd/mm/yyyy)……………………... Contact Address
Home address…………………………………………………………………
Contact Person (In case of emergency)
Phone No……………………….Email Address……..……………………... Mr./Ms/Mrs:……………………………………………………….………..….. Address………………………………………………………………………… Tel…………………………………..Fax………………………………………. Email address………………………..Relationship with applicant……………
Part B: Plan for Study Field /Program interest
…………………………………………………………………………………..
……………………..………………………………………………………….. Part C: Language literacy Language
Reading Good
English Others: Please specify …………..
Moderate
Writing Fair
Good
Moderate
Speaking Fair
Good
Moderate
Fair
Reading
Writing
Speaking
Language Good
Moderate
Fair
Good
Moderate
Fair
Good
Moderate
Fair
GPA in English Subject (in BCNNV) Others English Proficiency TOEFL IELTS Part D: A Motivation letter/ others information regarding your interest of program participation ………………………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………………………… I certify that all statement given in this application form are true. If any of them are found to be untrue after engagement, the college has the right to terminate my application
Applicant’s signature …………………… Date………….….