APPLICATION FORM FOR THE UNGRADUATE SCHOLARSHP PROGRAM

FOR ASEAN AND NON – ASEAN COUNTRIES

CHULALONGKORN UNIVESITY

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PART ONE : (to be completed by the applicant) headgear
3cm x 4cm
Application must be typed : Handwriting is not accepted

1. Name : Mr./Ms./Mrs.
First name Family name

2. Date of Birth : 3. Age:

(year) (month) (date)

4. Nationality : Thai Nationality

Dual Nationality, and

Passport Number

5. Name of the University/Institution :

City Country

Current Title/Position

6.a.Office address : Faculty Department

Tel Fax E-mail

b.Home address :

7. Academic qualifications :

High School

Institution Country

Field of study G.P.A.

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8. Please indicate which faculty of Chulalongkorn University you are applying for.

Faculty Department

Field of study

9. Language proficiency (“Poor”, “Fair”, “Good”, “Excellent”).

Foreign language Listening Reading Speaking Writing

1.
2.
3.

If you have taken the test of English as a Foreign Language (TOEFL or IELTS), what was your
score? (Please attach an official score report issued within the last two years).

10. Previous scholarships, fellowships, grants, and other honors or awards.

11. Are you applying for financial aid from government, international organization or other
than Chulalongkorn University? If so, please give details.

12. If you have visited or lived in any countries other than the one in which you are now
residing, please give places, dates, and purposes.
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13. Health insurance :

Chulalongkorn University has a hospital 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

Name of the medical insurance agency

No. of membership Address of the agency

14. Proposed plan of study (Write in detail/Attached additional page if necessary)

15. Plan after completing study at Chulalongkorn University.

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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Appendix

Conditions of Scholarships:
1.The scholarship period cannot be extended.
2. The recipients are not permitted to postpone a period of the scholarship acceptance as
proposed by Chulalongkorn University.
3. The recipients are not permitted to accept any employment in Thailand during the term of
their scholarships.
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.
5. The scholarship recipients must submit a study reports and study progress with the
approval from thesis advisor to the Office of Academic Affairs, Chulalongkorn University at the end of
each semester.

Provisions of the Scholarships :

The scholarships will cover the following :
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 Fees (tuition fees for faculty/special fees by the program are 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 scholarship recipient is deemed to be seriously ill and not physically fit to carry on with his/her studies.
2. GPA lower than 1.80 in 2 consecutive semesters.
3.Absence of scholarship recipients without notice or reasonable explanation.
Student departs Thailand for over 10 days without the consent of his/her academic advisor and
the 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 ______________

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Please check that you have enclosed all the relevant documents with your application:

 Completed application form. [application form for the Undergraduate Scholarship Program
for ASEAN and NON – ASEAN Countries]
 Curriculum Vitae
 Copy of Certificate of Graduation and an official transcript of academic records
 English proficiency score record
 Copy of passport
 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,
signed on the reverse side, one of which should be attached to the application form
 Two recommendation letters from the Head, the Director which the application belongs to.
 Nomination letter from the home institution.
 Physical examination certificate from a hospital in candidate’s home countries.
 An appendix.

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 of Applicant

Date