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