Student Code

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International Student/ Visitor  Information Form
Chiang Mai University


MR./MRS./MS.


        (NAME)                                                  (SURNAME)

Date of Birth: D/M/Y

Sex:                                   Male                                            Female
Marital Status:                Single                                          Married

Nationality
Passport No. or I.D. Card No.
Home Country
Address in Home Country :



Tel

E - Mail


Address to contact in case of emergency (while studying at CMU.)

House no

Lane (Soi)

Street

Subdistrict District

Province

Postcode Tel FAX

E-Mail


Faculty (in Chiang Mai University)

Department

Advisor

Date of Admission

Duration of Study


Status in Chiang Mai University

           Visitor      Special Porgram in

            International Dtudent in Faculty of

 I hereby declare that to the best of my knowledge the information supplied is correct and completed.   

Enclosed :

          Passport or   I.D Card                     Signature

          Health Certificate                                         Date
          Transcript
                (please certify coppy)
(Return to the Registrar Office)