Graduate School, Chulalongkorn University

Attach 1
Application Form for Scholarship for International Graduate Students
for Academic Year ………, Semester  1st  2nd inch
Photo
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 Scholarship
If 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 system

1. 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. Education
3.1 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 ..........)
3.2 Master’s degree:  Graduated  Studying in the last semester of academic year ............
……………….....
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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 thesis
5. 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).
............................................................................................................................................... ......................................
............................................................................................................................................... ......................................
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............................................................................................................................................... ......................................
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...….…....
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Expenses  Full Scholarship  Top-Up Scholarship+100th Ann. CU (PhD only)
(PhD only) 100th Ann. CU Top-Up
Tuition Fees ● Rate of Thai Student- Rate of Thai Student- Differential Part-
Rate of Non-Thai Student Support by Graduate School Support by Graduate School Support by Faculty/Program
● Differential Part-
Support by Faculty/Program
Stipend Support by Graduate School 9000 Baht Support by 1500 Baht Support by
10,500 THB/month Graduate School Graduate School
Transportation for ASEAN Support by Graduate School - Support by Graduate School
recipient (Round Trip) with
actual payment in economy
class
Accommodation Support by Graduate School - 50:50 Support by Graduate
5,500 THB/month for School and Faculty/Program
ASEAN recipient (stay at
CU I-House)
Special / Education Fees Support by Faculty/Program - Support by Faculty/Program
Research Expenses - Support by Graduate School -

Expenses  Top-Up Scholarship +  Top-Up Scholarship +

King’s 72nd Birthday Ann. (Master’s) Faculty/Program Scholarship(Master’s or PhD)
King’s 72nd Top-up Faculty/Program Top-up
Tuition Fees Rate of Thai Student- Differential Part- Rate of Thai Student- Differential Part-
Rate of Non-Thai Support by Graduate Support by Support by Graduate Support by
Student School Faculty/Program School Faculty/Program
Stipend 6000 Baht Support by 4500 Baht Support 5500 Baht Support by 5000 Baht Support by
10,500 THB/month Graduate School by Graduate School Graduate School Graduate School
Transportation for - Support by Graduate - Support by Graduate
ASEAN recipient School School
(Round Trip) with
actual payment in
economy class
Accommodation - 50:50 Support by - 50:50 Support by
5,500 THB/month Graduate School and Graduate School and
(stay at CU I-House) Faculty/Program Faculty/Program
Special / Education - Support by - Support by
Fees Faculty/Program Faculty/Program
Research Expenses Support by Graduate - - -
School

Remarks: King’s 72nd Birthday Ann. Scholarship and Thainess Study Scholarship are provided in the same rate.