Visa Requirements Please complete the form below. This information will be used to make the necessary visa documents. Student First Name Student Middle Name Student Last Name Student Grade Approximate total cost of student living in Chiang Rai and attending CRICS for one month Student receives financial support from (name and relationship): Student's nationality Student's race Student's religion Student's date of birth ?dd/mm/yyyy Student's Place of Birth: (State and Country) Father's name Father's nationality Father's race Father's occupation Father's religion Mother's name Mother's nationality Mother's race Mother's occupation Mother's religion Address of student in home country Address of parent in home country if different from above Student's address in Thailand if known Student's passport number Passport Country Passport Issue date Passport Expiration date Visa type ?Type O, Type ED Next page: Parent information Name of One Parent of Student; please complete the rest of the form based on one parent of the student. Relationship ?Father or Mother Date of birth ?dd/mm/yyyy Parent's Place of Birth: (State and Country) Have you been dismissed or fired from being a goverment official? Yes No If yes, please explain Have you been dismissed or fired from work? Yes No If yes, please explain Have you ever been in jail? Yes No If yes, please explain Highest degree held, major, and year of graduation Name of school, city, and state Passport number Passport country Issue date Passport Expiration date Visa type ?Type O, Type B, Type ED Next page: Work history Position Company Start date ?dd/mm/yyyy End date ?dd/mm/yyyy Reason for leaving Position Company Start Date End date Reason for leaving Name (First, Middle, Last Name) of Parent's father Nationality of Parent's father Occupation of Parent's father Religion of Parent's father Name (first, middle last) of Parent's mother Nationality of Parent's mother Occupation of parent's mother Religion of Parent's mother Please enter the text you see into the box. ?Please enter the characters you see into the box.