Application No. MAHIDOL UNIVERSITY INTERNATIONAL DEMONSTRATION SCHOOL (MUIDS)

APPLICATION FORM FOR ADMISSION Please use CAPITAL LETTER Student’s Name: (Title / Name / Surname)

Applying for Grade:

MUIDS is accepting applications for grade 10 (Matthayom 4) ONLY 

Prospective Students o

High School student, Both Thai and Expatriates, who are studying in or completed grade 9 (American Curriculum) or Year 10 (British Curriculum) or Mathayom 3 from accredited schools are eligible candidate for MUIDS



Admission Process o

Completed an application (either Write or Type) and prepare the following documents 

3 photos (size 1inch, recently taken)



1 copy of Official Transcripts (Mathayom 1-3(or Grade 7-9 in American Curriculum or Year 810 in British System). Transcripts written neither Thai nor English must be translated by certified organization (Please bring the original)



1 copy of Citizen id card and House Registration (both students and parents)

o

Submit to MUIDS with Admission Test Fee (including : Written Exam and Interview)

o

For more information contact: Tel: (662)441-0950 Ext. 113 Fax: (662)441-0964

Documents

Y

3 Photos Copy of Transcript Attached TOEFL Score (Optional)

N

Documents

Y

N

Documents

Copy of Citizen ID Card

TOEFL Score (IBT/ ITP)

Copy of House Registration

Recorded in Server

Y

N

We certify that the above information is complete, true and accurate and authorize the school to request further information and records for verification. We understand that if any information gained by the school through interviews or further reports does not match the information provided, any offer of admission may be revoked. Signature of the student

Signature of the parent

Signature of Officer

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Mahidol University Demonstration School (MUIDS) Mahidol Adulyadej – Phra Sri Nagarindra Building , 3 Rd Floor, 999 Phuttamonthon Sai 4 Road, Salaya, Phuttamonthon Nakhon Pathom, 73170, Tel : (662) 441-0950-3 Fax: ( 662) 441-0964 http://www.muids.mahidol.ac.th

STUDENT INFORMATION

PERSONAL INFORMATION (Please use CAPITAL LETTER) Title

First Name (English)

Middle Name

Last Name (English)

Title

First Name (Thai)

Middle Name

Last Name (Thai)

Nickname (English)

Nickname (Thai)

Gender

Religion

Other Religion

M/F Date of Birth (Day / Month / Year)

Nationality

Country of Birth

ID Card No/Passport No (without dash)

Expiration Date (Day / Month / Year)

Visa Type (for Non Thai Applicants)

Visa Exp. Date (Day / Month / Year)

First & Second Language

/ ADDRESS & LOCATION (Base on House Registration Book) House Id

House Number

Sub District

รหัสบ้ าน

Village name

Street

District

บ้ านเลขที่

ตาบล / แขวง

ชื่อหมู่บ้าน

อาเภอ / เขต

Soi

Trok

Country

ถนน

Zip Code

ซอย

ตรอก

จังหวัด

รหัสไปรษณีย์

Mailing Address & Location (Base on Present Address for Mailing purpose) Mailing Address (Home Number, Road, Tambol) : for sending post

Mailing District

Mailing Province

Student Mobile Phone Number

Student Home Phone Number

Student Lives with

If other, please specify below:

Mailing Country

Mailing Zip Code

Email Address

Apply for Admission to Grade

Need bus from/to Wongwienyai

YES | NO Do you have siblings at MUIDS or Mahidol University?

If Yes, please specify their name(s) and grade level(s) below:

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EDUCATIONAL HISTORY Age(s)

Grade(s)

Name of School

City & Country

GPA

Program Type

Grade 9 (US) Year 10 (UK) Mathayom 3 (TH)

Oversea. International Prog. English Prog. Thai Prog.

Grade 8 (US) Year 9 (UK) Mathayom 2 (TH)

Oversea. International Prog. English Prog. Thai Prog.

Grade 7 (US) Year 8 (UK) Mathayom 1 (TH)

Oversea. International Prog. English Prog. Thai Prog.

HONOR HISTORY Date

Grade(s)

Name of Honor

City & Country

MEDICAL HISTORY Question

Ans.

Has this student previously applied for admission to MUIDS?

Y|N

Has this student ever received special needs services?

Y|N

Has this student ever had a psychological evaluation?

Y|N

Is this student taking any medication on a regular basis?

Y|N

Does this student have any physical needs or limitation of which the school should be aware? Has this student ever been suspended or expelled from any school for any reason?

If Yes, Please fill in

Y|N Y|N

ACKNOWLEDGEMENT Please write down according to the given questions How do you know the school?

Why would you like to join our school?

What are the expectations of the students & parents with school

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FAMILY INFORMATION Father’s Name & Surname

Nationality

Education level

ชื่อ และ นามสกุล บิดา

Religion

Other Religion

Organization Name

Occupation Type

Other Type

Office Address:

Status: Married / Divorce / Deceased

Mobile Phone:

Work Phone:

Fax:

Email:

Mother’s Name:

Nationality

Education level

ชื่อ และ นามสกุล มารดา

Religion

Other Religion

Organization Name

Occupation Type

Other Type

Office Address:

Status: Married / Divorce / Deceased

Mobile Phone:

Work Phone:

Fax:

Email:

Guardian’s Name:

Nationality

Education level

Guardian’s Name (Thai)

Religion

Other Religion

Organization Name

Occupation Type

Other Type

Office Address:

Status:

Mobile Phone:

Work Phone:

Fax:

Email:

STUDENT FUTURE DECISION

What would you like to be in the future? Please explain your passion and requirement. Explain:

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