SCHOLARSHIP PROGRAM

Master or PhD Scholarship
SCHOLARSHIP APPLICATION FORM
ACADEMIC YEAR 20! 202
This applicatio" #$st %e se"t %& post 'i" ($plicate )ith the s$pporti"* (oc$#e"ts+ to,
Fre"ch E#%ass& - SCAC ! CS.
29 Sathorn Tai Road, Bangkok 10120
APPLICATION TO /E S./MITTED /EFORE, April0 1
r(
20
IDENTIFICATION
Mrs Ms Mr Single Married Other
Surname : Name :
Date of Birth : Place of birth :
Nationality (specify in case of dual nationality): T!"
CONTACT DETAILS 'to %e 2ille( i" CAPS LETTERS+ 3
ome !ddress :
#ity$To%n :
ome Phone :
&or' Phone :
Mobile Phone :
()mail !ddress :
3I#precise or i"acc$rate co"tact (etails )ill res$lt i" ca"cellatio" o2 the applicatio" 2or#4
French Embassy Scholarship Program 2011/2012 Page 1/4
Reser5e( 2or SCAC:
!pplication submitted on:
*ile n+: 206
*ield :
Liberté

Égal it é

Frat erni té
RÉ PUB LI QUE FRANÇAI S E
AMBASSADE DE FRANCE EN THAÏLANDE
Service de Coopération et d’ction C!lt!relle
INTENDED ST.DIES IN FRANCE
,e-el : Master . Master / PhD
0ni-ersity $ "nstitute :
#ity :
Name of degree prepared or research sub1ect:
Pre)enrolment process completed: 2es No
Name of the person in charge of the programme:
Position:
()mail address:
C.RRENT POSITION
0ni-ersity ) *aculty $ #ompany:
Name of the Degree $ Position:
*ield:
#ity: #ountry:
LAST DEGREE O/TAINED
Name (not abbre-iated):
,e-el:
0ni-ersity:
#ity: #ountry:
French Embassy Scholarship Program 2011/2012 Page 2/4
7OR8 E9PERIENCE OR INTERNSHIPS
Period #ompany Position
FOREIGN LANG.AGE LE:EL,
ENGLISH
,e-el:
"f applicable3 certificate (TO(*,3 TO("#3 "(,TS34 ): 2ear:
FRENCH
,e-el:
"f applicable3 certificate (D(*,3 D!*,3 T#*34): 2ear:
Pre-ious stay in *rance: No
2es3 specify the reason:

F.NDING ; TYPE OF SCHOLARSHIP
TYPE OF SCHOLARSHIP RE<.ESTED,
*ull Scholarship B#S or 5Social Protection6 Scholarship (only in case of co)
financing)
Did you loo' for any additional financial support from any other organisation (institutions3
international agencies3 uni-ersities3 pri-ate companies34) : No 2es3 specify:

ENGAGEMENT OF THE APPLICANT
"3 the undersigned (surname3 name)
certify that the abo-e information is complete and correct to my best 'no%ledge
declare that " ha-e read the *rench embassy scholarship ruleboo'3 completely agree %ith it
and commit myself to fully comply %ith it7
Date Signature :
French Embassy Scholarship Program 2011/2012 Page "/4
S.PPORTING DOC.MENTS RE<.IRED AND CHEC8 LIST
Doc$#e"ts to %e pro5i(e(0 i" Fre"ch or i" E"*lish0 $"(er pe"alt& o2 %ei"* (eclare( 5oi( ,
#omplete and signed Scholarship application (for the paper -ersion)
0p)to)date r8sum8 stating the entire curriculum
#o-er letter e9plaining moti-ations and interests in the planned pro1ect
#opies of academic diploma
0ni-ersity transcripts of the last t%o years of studies
"n addition3 2or Master le5el:
(nrolment attestation copy and$or correspondence bet%een the candidate and the host
uni-ersity in *rance
"n addition3 2or PhD:
Detailed description of the research pro1ect (/$: pages)
!n attestation signed by your tutor indicating his commitment to super-ise your thesis; or in
case of co)super-ision an attestation signed by the t%o super-isors (Thai and *rench)
indicating their commitment to super-ise in *rance and in Thailand if need be
Optio"al (oc$#e"ts ,
#ost)sharing commitment letter from the corresponding organisation
!cademic and$or professional recommendations
,anguage proficiency certificates: *rench (T#*3 D(,*3 D!,*3 academic degree34) and$or
(nglish (TO(*,3 TO("#3 etc7)
French Embassy Scholarship Program 2011/2012 Page 4/4