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  9. 9. Credit Transfer Form of 3 Thai-ASEAN Student Exchange Program 1. STUDENTS PERSONAL DATA (To be completed by the student. The information provided in this form will be treated in-confidence by the home and host institutions. Data from the form may be used for statistical purposes, but only in an aggregated and non-identifiable manner.)Last name: _ _ _ _ _ _ _ _ _ _ _ _ _ First name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __Home institution: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Country: _ _ _ _ _ _ __Date of birth: Sex: ----------------Student Identification Number: --------------------------2. DETAILS OF THE PROPOSED THAI-ASEAN STUDENT EXCHANGE PROGRAM (To be completed and signed by student and counter-signed by the academic staff members of both institutions.)Host institution: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Country: _ _ _ _ _ _ _ _ _ _ __ Host Institution Home Institution(If necessary, continue the list on a separate sheet, including any changes to be approved program, which must besigned and counter-signed)Students signature: _ _ _ _ _ _ _ _ _ _ _ _ _ __We confirm that the proposed program of study is approved. (Home institution staff member) (Host institution staff member) INSTITUTION STAMP INSTITUTION STAMP Date: _______________________ Dffie: _ _ _ _ _ _ _ _ _ _ _ _ _ __
  10. 10. -2­3. TRANSCRIPT OF THAI*ASEAN STUDENT EXCHANGE PROGRAM RESULTS4. CERTIFICATION OF THAI-ASEAN STUDENT EXCHANGE PROGRAM RESULTSHost institutionSigned: _ _ _ _ _ _ _ _ _ _ _ __(Signature of registrar/dean/administration officer)Date: _ _ _ _ _ _ _ _ _ _ _ _ _ __ INSTITUTION STAMPNOTE: This document is not valid without the signatures of the registrars/deans/ administration officers and stamps of the host and home institutions.

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