ELECTIVE TRAINING PROGRAMME FOR OVERSEAS STUDENT/ RESIDENT

Please read the following instructions before completing this form.

1. The program is provided in both clinical and non-clinical departments so that the student
can increase his/her knowledge in any specific field of interest. All our clinical department
are fully-equipped and provide a good opportunity to study tropical diseases.
2. For all departments, there will be no charge for tuition fee except Department of
Community Medicine. The elective/ exchange student interested in being trained in the
Department of Community Medicine and wants to work in a community hospital outside
the municipality of Khon Kaen. The elective/ exchange student will be responsible for
the bus fare to and from the community hospital.
3. Students will have to be responsible for their own transportation, food, accommodation
etc.
4. The decision to accept the application is under the authority of the department only. The
students schedule may need to be adjusted at the request of the department concerned.
5. The acceptance letter from the Faculty constitutes the final decision for the elective
requested.
6. Evaluation of the students' progress during their elective period may sometimes be issued.
7. Multimedia Presentation describing your experience is required.
8. Presentation and writing a brief report about your elective period is required.
9. Being an observer or available for practicals in medical practice is up to the consideration
of each department with each separate applicant.
10. If the applicant is permitted to be involved in medical practice, a temporary medical license
for foreign physician is needed.
11. Recommendation letter from the dean or professor of foreign elective student is required.
12. Students must pay for (or bring) their own anti-viral starter kits.
13. The visit of the elective exchange student will be in accordance with the Memorandum of
Understanding (MOU) between the Home Institution and the Faculty of Medicine, Khon
Kaen University (Host Institution).
14. Students are expected to dress properly on the wards is professional attire.
Men should wear a button-down shirt, slacks and white coat with leather shoes. Closed toe
shoes. No sneakers. No jeans or t-shirts.
Women should wear shirt or blouse, slacks or dress. No short skirts (use common sense
on length and look at others on the team), no lace, no bare arms or deep cut necklines.
Closed toe shoes, not sandals or sneakers. Pants are fine. No jeans.
Students are expected to wear a hospital gown when working in the wards. (Also bring
your own stethoscope if you would like to.)
Students should bring their own white gown and stethoscope
Please note that in Thai medical students wear uniforms and short white coats.
15. With reference to Khon Kaen Universitys Announcement Number 1470/ 2014 on
Principles and Procedures for International Students Health Security, student must have
medical/ health insurance coverage during your stay in Thailand.

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 APPLICATION FORM FOR ELECTIVE TRAINING PROGRAMME FOR
CLINICAL OVERSEAS STUDENT/ RESIDENT

For permission to undertake an elective period of studying in a department in the Faculty of Medicine:

PART A: General details (Typescript of black ink is preferred)

Last Name:
First Name: ...
Date of birth (date/ month/ year): .
Sex: Male Female Marital status: Single Married Other..
Country of legal nationality: .
Address for correspondence: ...
...
...
...
...
Telephone number:.... Fax number (if applicable):...............................
E-mail address:...
Facebook: Line: Whatsapp:..
How did you hear about the Faculty of Medicine, Khon Kaen University?
...
...
...

PART B: Academic History (Please note your degrees obtained or expected)

Medical education background and degrees obtained:..
...
Year to Year Degree obtained/ expected University/Institution

Date (month/year) you commenced your medical studies:...

Date (month/year) you graduated will graduate as a doctor:..

Applicant is a/ an Undergraduate Medical Student Postgraduate Student

Postgraduate Clinical Fellow Postgraduate Clinical Resident

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PART C: Details required concerning Medical School
Full address of applicant's Medical School:...

Full name and title of the applicant's dean

Last Name:
First Name: ...
Title: ..........
Full name and title of the applicant's advisor
Last Name:
First Name: ...
Title: ..........
Email: ..........
Total length of medical course in applicant's school ......years Applicant is in the year.
PART D: Elective Choices (Please tick the choice)
Duration of your elective from (D/M/Y) ....to ...total......weeks
Please indicate applicant's elective Department and duration. One or more departments/divisions can
be chosen.
Special Requirement*
1) All clinical electives start on the 1st Monday of the month at 7:45 am. Please arrange everything (e. g. flight) to ensure that youll
be able to be at the Department of your choice on time
2) Please consider, that some subjects may not be available during the period intended
3) Elective duration must be at least 2 WEEKS per one department/division
4) Elective duration should be start on Monday and finish on Friday
Anesthesiology........weeks from (D/M/Y) ....to ...
Community Medicine........weeks from (D/M/Y) ....to ...
Emergency Medicine........weeks from (D/M/Y) ....to ...
Forensic Medicine........weeks from (D/M/Y) ....to ...
Medicine........weeks from (D/M/Y) ....to ...
Obstetrics and Gynecology........weeks from (D/M/Y) ....to ...
Ophthalmology........weeks from (D/M/Y) ....to ...
Orthopedics........weeks from (D/M/Y) ....to ...
Otorhinolaryngology........weeks from (D/M/Y) ....to ...
Pediatrics.......weeks from (D/M/Y) ....to ...
Psychiatry........weeks from (D/M/Y) ....to ...
Radiology........weeks from (D/M/Y) ....to ...
Rehabilitation Medicine........weeks from (D/M/Y) ....to ...
Surgery........weeks from (D/M/Y) ....to ...
(Please specify the Division you would like to elective) Division of Neurological Surgery
Division of Cardiovascular and Thoracic Surgery Division of Pediatric Surgery
Division of General Surgery Division of Plastic Surgery
Other........weeks from (D/M/Y) ....to ...
Expected arrival in Khon Kaen (D/M/Y) ....
PART E: These items should be attached to the application:
Special Requirement* The application documents have to be passed on to the International Relations Office at least 3 month prior to arrival.
Nomination or Reference letter from the Home University
Official transcript (in English or with an authorized translation)
Copy of passport with your personal data
A recent passport-sized photo

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 Medical report (including negative HIV test and Hepatitis B vaccination, certification of not
having chronic infectious disease)
Vaccination certificate https://goo.gl/iVoqbD
English Proficiency Score (for non-native speakers)
An international insurance (health and accident) is compulsory for the period of your stay in
Thailand. It has to be valid for Thailand and for the whole duration of your stay. The relevant
documents have to be sent to the International Relations Office prior to your arrival.
The regulation of KKU (Announcement in 2014 No. 1470/2014), student MUST HAVE Health Insurance covering the period of your study.

PART F: The following may sometimes be arranged, please indicate your preference
(Indicate preferences with numbers)
Medical student dormitory (Twin Room) Photo: https://goo.gl/OQ6h4U
Private Apartment with reasonable price
Sorento Hotel, http://www.sorrentokhonkaen.com/hotel/services-hotelen.html
The room fee is 5000 baht/ month (the price is subject to change without prior notice),
deposit 5000 baht, bedding set 400 baht, WiFi 200 baht exclude water tap and electricity 7
bath and 11 baht per unit. It takes 10 - 15 minute walk to our hospital.
Angarb International House, http://www.angarb-ih.com/index.html#photoG
The room fee is 4000 baht/ month (the price is subject to change without prior notice),
deposit 5000 baht/ room, Room's Key 200 baht, WiFi 100 baht/ account, Cable TV rental
150 baht/room exclude water tap and electricity 7 bath and 25 baht per unit. It takes 15 -
20 minute walk to our hospital.
Hotel
The Impress Khon Kaen Hotel, http://www.theimpresshotel.com/225941735
Standard Room (1 person) 500 baht/ night excluded breakfast 100 baht/ person
Superior Room (2 person) 600 baht/ night excluded breakfast 200 baht/ 2person
You have to pay deposit for a rooms key 250 baht (will return when you check out).
Kwanmor Hotel http://home.kku.ac.th/kwanmor/accommodation.php
Standard Room (2 person) 700 baht/ night included breakfast

Not required Other..............................

Remark* If you want to reserve a room by yourself, please check the location is closed to the Srinagarind hospital.
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I declare that the statements made on this form are correct.

Signature.................................................Date........
Applicant

Please kindly return and send the application and required documents to:
Associate Dean for International Relations and Cooperation Strategies
Faculty of Medicine, Khon Kaen University 40002 THAILAND
Tel: +66-(0)43-36-3466, 36-3491, 36-3122 Fax: +66-(0)43-34-8375
E-mail: intermed@kku.ac.th Website: http://www.intermed.kku.ac.th/

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