Chulalongkorn University
Application form for
One SemesterScholarship Program
for the students from ASEAN Countries
PERSONAL PROFILE (Information must be typed)
Mr./Miss/Mrs./Other ______
First Name Middle Name Last Name
Sex Male Female Date of Birth _____/______/______
Day Month Year
Nationality ______Passport Number______
Current Address ______
Street City ______Tel: ______
State Zip Code Country
Fax: ______E-Mail: ______
Proposed level and field of study at Chulalongkorn University:
Bachelor’s Master Ph.D.
Field of study : ______Faculty: ______
Details of all programs:
Details of all international programs:
Semester in which you will enroll. The scholarships that we now offer are only for the semesters shown below.
International System Second (Jan–April 2018)
Academic Year 2017 / Two-Semester System
Second(Jan-April 2018)
Academic Year 2017
- International System is used for all international Bachelor’s programs and some international graduate programs.
- Two-Semester System is used for all regular programs taught in Thai and for almost all international graduate programs.
Proposed Grading System for credit transfer to your university:
Standard grading system with A, B, C, D and F
Grading with “S” for Satisfactory or “U” for Unsatisfactory (with examination)
Grading with “V” for Visitor or “W” for withdrawn (without examination)
EDUCATIONAL INFORMATION
Home University ______Country ______
Currently status : Studying Undergraduate/ Year of study……..… ID student …………….………
Field of study
Faculty G.P.A
studying Graduate (Master/Ph.D.) /Year of study…….ID student ……………………
Field of study
Faculty G.P.A
Educational Background
Institution Location Major/Field of study Period of attendance Degree obtained
______
______
______
English Proficiency: (for non-native speaker)
(a)Have you completed a TOEFL test or equivalent in the last twelve month?
Yes, score:______ No
(b)Do you intend to sit for a TOEFL test or equivalent in the immediate future?
Yes No
If yes, please provide details of test and date.______
(c)Indicate your English proficiency
Excellent Good Fair Poor
Reading
Writing
Speaking
Listening
Thai Proficiency:
(a)Indicate your Thai proficiency
Excellent Good Fair Poor
Reading
Writing
Speaking
Listening
Study Plan: (Please use a separate sheet if necessary.)
Faculty: ______
Major: ______
______
______
______
______
______
______
______
______
______
______
______
______
______
______
______
______
I declare that the information given is true and correct to the best of my knowledge and that if I have been awarded a scholarship, I agree to comply with the rules and regulations of Chulalongkorn University.
Signature of Applicant
Date
HOME UNIVERSITY APPROVAL : To be signed by Dean of Faculty/Head of Department or Director of administrative office
We certify that Mr./Ms. is our currently
studying an undergraduate student: Year of study
studying graduate student (Master/Ph.D.) Year of study
has been approved for participation inthe scholarship programfor one semester but not more than 4 monthsfor the following periods:
From (Month, year) ______To ______
Signed______
(______)
Title______
Date ______
Appendix
Conditions of Scholarships
1. The scholarship period cannot be extended.
2. The recipients are not permitted to accept any employment in Thailand during the term of their scholarships.
3. The recipients are not permitted to bring any of their family members with them.
4. The recipients are not permitted to postpone a period of the scholarship acceptance as proposed by Chulalongkorn University.
5. The recipients must residence in Thailand during the scholarship period
In case of the scholarship recipient whishes to leave Thailand during the semester, he/she has to inform the University of his/her departure through the Advisor where he/she is studying and the advisor must give assurance that his/her absence will not interrupt his/her studies. Once the request is approved by the University, the scholarship recipient will be able to depart. In this regard, the University will not be responsible for the airfare. If his/her absence is more than 10 days, he/she willnot be entitled to the living allowance for the month (s) of his/her absence.
Term of Scholarships :
1 Semester (4 months)
Provisions of the Scholarships :
The scholarships will cover the following :
1. An economy class round-trip ticket to and from designated capital cities or principal cities
2. Tuition and Fees
3. Stipend and accommodation in the amount of 16,000 baht/month.
Health insurance :
Chulalongkorn University has a health service center facility. However, foreign students must have
comprehensive health insurance policy to cover medical services in case of serious illness requiring
hospitalization. If not, all medical expenses incurred will be borne by recipients.
Suspension and termination of scholarships :
These scholarships will be suspended or terminated for the following reasons :
1. Serious illness of recipients.
The recipient is deemed to be seriously ill and not physically fit to carry on with his/herstudies.
2. Absence of recipients
Student departs Thailand for over 10 days without the consent of his/her academic Advisor andapproved by the University
I accepted the information provided above is the best of my knowledge. If I have been awarded a scholarship, I agree to comply with the rules and regulations of Chulalongkorn University.
Signature of Applicant ______Date ______
Please check that you have enclosed all the relevant documents with your application:
A completed application form. [application form for 1 Semester scholarship program for ASENN Countries]
A nomination letter from home institution/university.
An official transcript of academic records (to be issued by the institute presently being attended)
An English proficiency score record (for non-native speaker of English)*
A copy of passport
A copy of student Card
Study plan / description of academic interests (on a separate sheet of A4-sized paper)
Two 1-inch-colored photos (with blue background) taken no more than six months in polite attire or the uniform, signed on the reverse side, one of which should be attached to the application form
An appendix.
* International Programs may have an additional required.
Send all application documentsdirectly to the faculty/program of their choice. Please note that the application date and selection schedule of the applicants has set by each of the faculty/program.
Signature ______Date ______
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