Chulalongkorn University



Chulalongkorn University

Application form for

One Semester Scholarship Program

for ASEAN and NON-ASEAN Countries

PERSONAL PROFILE (Information must be typed)

Mr./Miss/Mrs./Other _______________________________________________________________________

First 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: ____________________________

The scholarships that we now offer are only for the semesters shown below.

| | |

| | Two-Semester System | |

| |( Second (Jan – April 2021) | |

| |Academic Year 2020 | |

| | | |

• 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( Grading with “V” for Visitor or “W” for withdrawn (without examination)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 …………….………

( Studying Graduate (Master/Ph.D.) /Year of study…….. ID student ………………….…

( Faculty Member/Researcher/Academic Staff

Educational Background

Institution Location Major/Field of study Period of attendance Degree obtained

______________________ _______________ ____________________ ________________ ____________

______________________ _______________ ____________________ ________________ ____________

______________________ _______________ ____________________ ________________ ____________

English Proficiency: (please attach the score report)

( TOEFL score:_____________________

( IELTS score

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/Director or Registrar 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

( Faculty Member/Researcher/Academic Staff

has been approved for participation in the scholarship program for one semester but not more than 4 months for the following scholarship periods:

From (Month, year) ( 2021 To 2021

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 postpone a period of the scholarship acceptance as proposed by Chulalongkorn University.

4. 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 will not be entitled to the living allowance for the month (s) of his/her absence. Students who leave Thailand before the term of scholarship, the University will not support both of living allowance and the airfare.

Term of Scholarships :

1 Semester (4 months)

Provisions of the Scholarships :

1. An economy class, round trip ticket, as actual paid. It should be noted that

1.1 For students from ASEAN, the airfare of each leg of the trip must not exceed 8,500 Baht;

1.2 For students from Asian countries, the airfare of each leg of the trip must not exceed

12,000 Baht;

1.3 For students from Europe, Australia and New Zealand as well as Africa, the airfare of

each leg must not exceed 20,000 Baht;

1.4 For students from North and South America, the airfare of each leg must not exceed

30,000 Baht.

2. Tuition and Fees (special fees by the program is excluded)

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/her studies.

2. Absence of recipients

Student departs Thailand for over 10 days without the consent of his/her academic Advisor and approved 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 One Semester Scholarship Program for ASEAN and NON - ASEAN Countreis]

← 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; 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 documents directly 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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