Chulalongkorn University

Application form for

One Semester Scholarship Program
for ASEAN and NON-ASEAN Countries
Attach Photo
Here

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: http://www.academic.chula.ac.th/search/search.asp

Details of all international programs:
http://www.inter.chula.ac.th/inter/internationalstudents/InterProgramList.html

Semester in which you will enroll. The scholarships that we now offer are only for the semesters shown
below.

International System Two-Semester System

 First (Aug – Nov 2019)  First (Aug- Nov 2019)
Academic Year 2019 Academic Year 2019
 Second (Jan – April 2020)  Second (Jan – April 2020)
Academic Year 2019 Academic Year 2019

 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 Grading with “V” for Visitor or “W” for withdrawn (without examination)

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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: (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    

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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

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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 periods:

From (Month, year) ________________________ To ________________________

Signed ________________________________________________

(_______________________________________________)

Title_____________________________________________

Date ____________________________________________

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 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.

Term of Scholarships :
1 Semester (4 months)

Provisions of the Scholarships :

1.An economy class round-trip ticket to and from designated capital cities or principal cities.
(actual paid)
1.1 ASEAN Countries not more than 8,500 baht for one way
1.2 ASIA not more than 12,000 baht for one way
1.3 EUROPE, AUSTRALIA, NEW ZEALAND and AFRICA not more than
20,000 baht for one way
1.4 NORTH and SOUTH AMERICA not more than 30,000 baht for one way
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:

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  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 (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 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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