INSTITUTE OF HUMAN RIGHTS AND PEACE STUDIES

Panyaphiphat Building, Mahidol University

Salaya, Nakorn Pathom, 73170 THAILAND

Tel: 66-2-4410813-15 ext. 1114 Fax: 66-2-4410872

Email:

APPLICATION FORM

LAST NAME/FAMILY NAME: ………………….…….FIRST NAME:…………………..……………

MIDDLE NAME:……………………………..………..…TITLE……………………......

GENDER: Male Female

DATE OF BIRTH
(day / month / year)

nationality: ……………………………………………………………………………………………..

PERMANENT ADDRESS:
Email:
Tel:
Fax: / CORRESPONDENCE ADDRESS:
(if other than the permanent address)
Email:
Tel:
Fax:

Please enter, in chronological order, details of all degree or diploma programmes attended since leaving school.Please supply certified copies of your academic transcripts and certificates with English translations.

Year of
Attendance / Institution/Country / Study Programme / Qualification or Degree Acquired
From / To

Please give details of research and publications you have undertaken. In the Description please state the type of publication(for example dissertation, undergraduate or postgraduate research project, NGO research); and state if you were the individual author or with a research team.

Year / Title / Description / Language of Publication

Please give details of recent employment and/or professional experiences.

year / Name of organization or employer / Position
From / To

On attached sheets, please write your personal statement of approximately two pages long, describing in detail:

1. Your particular academic interests

2. Your purpose and objectives in undertaking this study programme

3. Ideas for your master’s thesis in human rights studies

4. Your related experiences in the field of human rights, including full-time and part-time professional experiences and volunteer works.

* Is English your first language?Yes

No

* If English is not your first language:

1. Have you done an English proficiency test(TOEFL or IELTS). If so please give the results, the date(s) when taken, and the score(s) you have obtained. (An official certificate of each test must be attached).

Test / Date of Test / Score

Or

2. Have you studied in an English language curriculum? If so please give details:

…………………………………………………………………………………………………….

We request two confidential references from persons of high academic or professional standing who are well acquainted with you and your academic and professional work. Each of the referees must fill in the reference form (which can be found at the end of this application form) and send it directly to the IHRP email address (). The referees may submit their form by email. Below, please give details of the two referees. Please send the reference form to your referees.

Referee 1
Name:
Position:
Institution:
Email:
Tel: / Referee 2
Name:
Position:
Institution:
Email:
Tel:

How would you finance yourself at Mahidol?

Self/FamilyEmployer

 ScholarshipName of scholarship ………………………………………………………………...

Have you obtained the scholarship? Yes No

 In the absence of a scholarship, will you be able to meet the cost of your proposed course?

 Yes No

 Completed the application form

 Signed and dated the form

 Attached personal statement

 Attached academic transcript(s)

 Attached English language test certificate(s)

 Attached separate details of academic and/or employment history (if any)

 Contacted the referees and send them the reference form

To help us with our promotion activities, please indicate how you were informed about this programme of study at MahidolUniversity.

IHRP Website

Search Engine……………………………….(Please specify)

IHRP Facebook page

Mahidol University information

Our students or alumni

Our faculty members or supporting staff

Others (please specify) …………………………………………………..

Successful candidates will be contacted via email.

1

Dear Referee,

Please fill out this form and send it directly to the Institute of Human Rights and Peace Studies at Mahidol University by email (preferred) to , or mail at the address below.

1. Name of applicant: ……………………………………………..…………………………………………..

2. I have known the applicant for ………………………(years)

In his/her capacity as…………………………………………………………………………………………...

3. In the box below rate the applicant’s academic abilities. Please tick the appropriate box:

Top 10% / Above Average / Average / Below Average / Poor / Don’t know
Academic ability
Written expression
Oral expression
Research ability
Ability to work independently
Critical analysis
Motivation for study
Knowledge of human rights

4. How would you rate the applicant’s proficiency in spoken and written English?

………………………………………………………………………………………………………………….

5. Please attach one page comment on the applicant’s suitability to undertaking a MA programme. In particular, we will appreciate your genuine assessment of the applicant’s ability to undertake a research project, to produce academic papers, and interest in human rights. Please attach this to the form.

6. Referee’s name: ……………………………………………………………………………………………..

Position: ………………………………………………………………………………………………………..

Institution: ……………………………………………………………………………………………………..

Telephone: ……………………………………………………………………………………………………..

Email: ………………………………………………………………………………………………………….

Please note, we may contact you for further information about the applicant.

Signature: ……………………………………………….……Date………….………………………………

Please send this form and the attached comments to:

INSTITUTE OF HUMAN RIGHTS AND PEACE STUDIES

Panyaphiphat Building, Mahidol University

Salaya, Nakorn Pathom, 73170 THAILAND

Tel: 66-2-441 0813-15 ext. 1114

Fax: 66-2-441 0872

Email: