บัณฑิตวิทยาลัย จุฬาลงกรณ์มหาวิทยาลัย



5600065-13318 Attach 1 inchPhoto00 Attach 1 inchPhoto Graduate School, Chulalongkorn UniversityApplication Form for Scholarship for International Graduate Studentsfor Academic Year ………, Semester 1st 2nd Please fill in the form with clear handwriting/typing or Full Scholarship (PhD only) Apply for a PhD program with Master’s degree holder Transferring from a master’s to doctoral degree Top-Up ScholarshipIf Top-Up Scholarship, please indicate your another awarded applied scholarship The 100th Anniversary Chulalongkorn University Fund for Doctoral Scholarship H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship Thainess Study Scholarship Scholarship of the Faculty/Program ………………………………………………………………………..….. Other (Specify) ………………………………………………………………………………………………….Apply for a Master’s degree program a PhD program with Bachelor’s degree holder Master’s degree holder Transferring from a master’s to doctoral degree Enclose documents as the following. Scholarship Application Form A copy of transcript A copy of degree certificate or a document certifying that you are going to graduate soon. A 1-inch photo attached with the scholarship application form A copy of your passport or ID card A copy of your English proficiency test (CU-TEP, TOEFL or IELTS, valid within two years) If your university grading system is not a full scale of 4.00 and the equivalent grade is not indicated in your transcript, you must give one of the following additional documents. an equivalent average grade to the full scale of 4.00 issued by your university or your honor Bachelor’s degree system1.Mr./Mrs./Miss/MS .......................................................................................................... (First, Middle and Last name) Date of Birth : .......................................................................... (Date/Month/Year) Age............................Years Nationality: ................................................. Passport Number: .................................................................................2.Current address: No..............................….....................…...…............................…..............................................…….............…...…............................…..............................................…….............…...…...................................Zip code ……............ Country…………………..……............… Home phone .…..............…...............................… Mobile phone.......................…….................... E-mail…………........................................…................................3.Education3.1 Bachelor’s degree: Graduated Studying in the last semester of academic year .............….......................Field of Study ……………….........…………………… Faculty..........................................……….............. University...….….........……...................................................... GPAX…......................................................................... 1st Class honor 2nd Class honor Others (Please specify)………………………………………… (Grading system of your university in a Bachelor’s degree level: Full scale..........., 2nd Class honor of ..........)3.2Master’s degree: Graduated Studying in the last semester of academic year ............……………….....Field of Study ……………….........…………………… Faculty..........................................……….............. University...….….........……....................................................... GPAX…........................................................................ (Grading system of your university in a Bachelor’s degree level: Full scale.........., 2nd Class honor of ..........)3.3 Currently approved to transfer from a master’s to doctoral degree at Chulalongkorn University. Field of Study ……………….........……… Faculty........................................................ GPAX…............ 4.The field/program/faculty of Chulalongkorn University which you are interested: I will apply for I am applying for I was accepted Field of Study .............................................................................Faculty............................................................... Thesis only Coursework and Thesis Non thesis5. English proficiency score: CU-TEP.................... TOEFL……….……….. IELTS…………….………. 6. Previous scholarships, fellowships, grants, and other honors or awards................................................................................................................................................ ..................................................................................................................................................................................... ..................................................................................................................................................................................... ..................................................................................................................................................................................... ..................................................................................................................................................................................... ..................................................................................................................................................................................... ..................................................................................................................................................................................... ......................................7. Are you applying for financial aid from government or other international organizations? If so, please give details................................................................................................................................................ ..................................................................................................................................................................................... ..................................................................................................................................................................................... ..................................................................................................................................................................................... ......................................8. Health insurance: Chulalongkorn University has a hospital facility. However, foreign students must have comprehensive health insurance to cover medical services in case of serious illness requiring hospitalization. If not, all medical expenses incurred will be done by recipients. Have no health insurance and will apply later. Have health insurance with the medical insurance agency ...................................... ................................... No. of membership ...................................... Address of the agency .................................................................9. Publications : (Attach additional pages if necessary)................................................................................................................................................ ..................................................................................................................................................................................... ..................................................................................................................................................................................... ......................................10. Proposed plan of study or research (Write in detail)............................................................................................................................................... ..................................................................................................................................................................................... ..................................................................................................................................................................................... ..................................................................................................................................................................................... ......................................I declare that the given information 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 Applicant’s signature ……………..…………………………………………. Date………..……Month…………..…..……Year……….…….Department/Program’s recommendation of the applicant’s eligibility……………………………………………………………………............................…………………..............……………………………………………………………………............................………………….............……………………………………………………………………............................………………….............. ......................……….................... Signature of program’s director/head of department (…...…..………...............….…….…………………….) Date ……..………Month……………..…..…Year………….Scholarship nomination The Faculty program would like to nominate Mr./Mrs./Miss ……………..…..………………..…..….............................................................................................................., who will apply for studying is applying for studying is accepted to study in the faculty/program, for Full Scholarship Top-Up Scholarship. The Faculty program will support the differential part of tuition fees and whole special fees, and will also share the support of accommodation of this applicant as detailed in an enclosed page. .........................….……………............................ Signature of Dean/ Interdisciplinary program’s director (..........…...…..………….…………..........…………………….) Date ............….Month……….............Year...….…....Expenses Full Scholarship (PhD only) Top-Up Scholarship+100th Ann. CU (PhD only)100th Ann. CUTop-UpTuition FeesRate of Non-Thai Student● Rate of Thai Student-Support by Graduate School● Differential Part-Support by Faculty/ProgramRate of Thai Student-Support by Graduate SchoolDifferential Part-Support by Faculty/ProgramStipend10,500 THB/monthSupport by Graduate School9000 Baht Support by Graduate School1500 Baht Support by Graduate SchoolTransportation for ASEAN recipient (Round Trip) with actual payment in economy classSupport by Graduate School-Support by Graduate SchoolAccommodation5,500 THB/month for ASEAN recipient (stay at CU I-House)Support by Graduate School-50:50 Support by Graduate School and Faculty/ProgramSpecial / Education FeesSupport by Faculty/Program-Support by Faculty/ProgramResearch Expenses-Support by Graduate School-Expenses Top-Up Scholarship +King’s 72nd Birthday Ann. (Master’s) Top-Up Scholarship +Faculty/Program Scholarship(Master’s or PhD)King’s 72ndTop-upFaculty/ProgramTop-upTuition FeesRate of Non-Thai StudentRate of Thai Student-Support by Graduate SchoolDifferential Part-Support by Faculty/ProgramRate of Thai Student-Support by Graduate SchoolDifferential Part-Support by Faculty/ProgramStipend10,500 THB/month6000 Baht Support by Graduate School4500 Baht Support by Graduate School5500 Baht Support by Graduate School5000 Baht Support by Graduate SchoolTransportation for ASEAN recipient(Round Trip) with actual payment in economy class -Support by Graduate School-Support by Graduate SchoolAccommodation5,500 THB/month (stay at CU I-House)-50:50 Support by Graduate School and Faculty/Program-50:50 Support by Graduate School and Faculty/ProgramSpecial / Education Fees-Support by Faculty/Program-Support by Faculty/ProgramResearch ExpensesSupport by Graduate School---Remarks: King’s 72nd Birthday Ann. Scholarship and Thainess Study Scholarship are provided in the same rate. ................
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