Application No:
MAE FAH LUANG UNIVERSITY Application for Admission Bachelor’s Degree
Master’s Degree
Attach photo here (size 1”)
Doctoral Degree
1. APPLICANT INFORMATION First Name Middle Name Last Name Passport Number Date of Issue
2. PERSONAL DETAILS
Place of Issue Date
Male
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Month
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Year
Expiration Date
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Month
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Year
Female
Nationality
Religion
Place of Birth
Date of Birth
Age
Blood Group
(a) Address Permanent Address Postal Code Telephone (Home)
Telephone (Mobile)
Fax
(b) Current address used for postage (if different from permanent address) Current Address
Postal Code Telephone (Home)
Telephone (Mobile)
Fax
(c) Contact person (in case of emergency) Name
Date
Telephone
Date
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Month
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Year