Application Form Bachelor's Degree Academic Year 2017

King Mongkut's University of Technology Thonburi

Application Information
Application No. : 601201319526
Application Type : Direct Admission
Photo 1 inch
Academic Year : 2017
Project Type(Eng) : International Admission for Undergraduate Program 1/2017
Degree of Application : Bachelor
Major Code : Enviromental Engineering (International Program) - B.Eng.
Department : -
Faculty : Faculty of Engineering

Applicant's Information
Passport No. : A 5347605
Name (Eng) : Mr.Akmal Alfarizi
Sex : Male
Date of Birth : 16/11/1998 Age : 18
Nationality : INDONESIAN Race : INDONESIAN
Religion : Islam Blood Group : AB
Educational Data
Country of School : Jalan Belitung No. 8 Bandung Jawa Barat
School Code : -
School Name : SMA Negeri 3 Bandung
Degree : High School / Grade 12 Certificate
GPAX : 3.47
English Language Proficiency
English Test Score Test Date
TOEFL IBT (Internet Based Test) 74.00 13/11/2016
SAT (Scholastic Assessment Test) 1950.00 05/11/2016
Personal Information / Family Information
Country of Address : Indonesia
Curent Address : Taman Graha Asri B4/3 Serang Banten
Telephone No. : +62895359786907
Mobile No. : -
E-mail : akmalalfz@gmail.com
Talent :
Father's Name :
Nationality : - Race : -
Mobile No. : -
Mother's Name :
Nationality : - Race : -
Mobile No. : -
Documents
List of Documents for Application Uploaded File
Degree transcripts (Translated into English and get Certified by their own Embassy, or issue in
English by their University or the Equivalent Graduate School)
Curriculum Vitae (CV)
Statement of purpose (Maximum 1000 characters)
English language certificate
Copy of Passport
Two Letters of Recommendation

I have completed the application form and attached all required official documents.If at any time it is discovered that I
revoke my status as a application of KMUTT, application fee and my status as a student of KMUTT.

Date submitted 11/12/2016

Applicant signature ........................................................
Date ............./........................./.................