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2020 Application Form Master ITC

This document is an application form for a master's program at the Institute of Technology of Cambodia Graduate School for the 2020-2021 academic year. The applicant, Phanna Mong, is applying for the Master of Materials and Structures program. They are currently working as a site engineer in Battambang Province and their bachelor's degree is in civil engineering. The application requires information about the applicant's educational background, language proficiency, work experience, and submission of supporting documents by the August 31st deadline.

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Mong Phanna
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54 views

2020 Application Form Master ITC

This document is an application form for a master's program at the Institute of Technology of Cambodia Graduate School for the 2020-2021 academic year. The applicant, Phanna Mong, is applying for the Master of Materials and Structures program. They are currently working as a site engineer in Battambang Province and their bachelor's degree is in civil engineering. The application requires information about the applicant's educational background, language proficiency, work experience, and submission of supporting documents by the August 31st deadline.

Uploaded by

Mong Phanna
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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INSTITUTE OF TECHNOLOGY OF CAMBODIA

GRADUATE SCHOOL

Application Form for Master’s Program


Academic Year: 2020-2021

Please choose a program* Type of Diploma*


 Master of Materials and Structures  Regular Degree
☐ Master of Water and Environmental Engineering ☐ Double Diploma
☐ Master of Agro-Industry
☐ Master of Mobile Technology Will you apply for a scholarship?
☐ Master of Energy Technology and Management (if yes, please specify) *
☐ Master of Intelligent Mechatronics ☐ No
☐ Master of Transport Engineering ☐ Yes LBE Program

Registration
☐ 1st registration M1
 1st registration M2
☐ Re-registration _______

* please see details of each program in the leaflet for the possible types of
diploma and scholarship via this link https://bit.ly/itcmaster2020-21

1 Particular of Applicant

Family name: MONG Given name: Phanna_


Marital status: Single Gender:  Male ☐ Female Date of Birth: 19/April/1996Place of birth:
KampongChhnang I village, Bavel commune, Bavel distict, Battambang Province.
Country of Birth: Cambodia Nationality: Cambodian_

Current Contact Information


Address: KampongChhnang I village, Bavel commune, Bavel distict, Battambang Province.
Postal code: 855Province/City: Battambang Country: Cambodia
Phone number: 078 424 966 Email Address: [email protected]

Secondary Contact Information (We will use this address if we cannot reach you at the first address)
Contact person’s name : Hem Noy Address: Battambang
Postal code: 855Province/City: BattambangCountry: Cambodia
Phone number: 012 366 541 Email Address: __________________________________________

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2 Educational Background (List all colleges and universities previously attended, if applicable, in chronological order. Use a
separate sheet for additional information.)

Have you graduated from ITC?  No ☐ Yes


If yes, please state year of completion : ____________ Major: _________________________________________

High School Diploma


Grade: D Year: 2014 Province/City: BattambangCountry: Cambodia
Educational Institution: Bavel high school

Higher Education
a. Institution, city and country: University of Battambang, Cambodia
Major/Field of study: Civil engineering
Period of study (mm/yyyy-mm/yyyy): 10 /2014 - 10 /2019 Graduation date (or expected): 11/2019
Degree obtained or expected: Bachelor degree of civil engineering
b. Institution, city and country: ________________________________________________________________
Major/Field of study: ______________________________________________________________________
Period of study (mm/yyyy-mm/yyyy): _ _ /_ _ _ _ - _ _ /_ _ _ _ Graduation date (or expected):_______________

Degree obtained or expected: _______________________________________________________________

3 Foreign Language Proficiency


Excellent Good Fair Poor
English Reading ☐  ☐ ☐
Writing ☐  ☐ ☐
Certificate: Level 07
Delivery date: __________ Speaking ☐  ☐ ☐
Listening ☐  ☐ ☐
Excellent Good Fair Poor
Other language Reading ☐  ☐ ☐
(French) Writing ☐  ☐ ☐
Certificate: A2_ Speaking ☐  ☐ ☐
Delivery date: __________ Listening ☐  ☐ ☐

4 Work Experiences
(A) List your work experiences in order
From To Institution/Location Title/Position

01/08/18 01/02/19 N K R S Co LTD / Battambang Province. Site engineering


_______ _______ _____________________________________________ ______________________
_______ _______ _____________________________________________ ______________________

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(B) Describe your work experiences related to this proposed study program
My work base on structure of building. The process of this work is to construct the referral hospital building. Focus
on the shear wall. I think that my internship is related to the study program, Master of Materials and Structures._

5 Documents* required to be submitted (only in Khmer, English or French):

a. CV with a photo ............................................................................................................................ 1 copy


b. Recent photos 4x6 (with name label on the back side) ................................................................. 6 copies
c. Baccalaureate or equivalent diploma *.......................................................................................... 1 copy
d. Bachelor degree, engineer degree or equivalent diploma *........................................................... 1 copy
e. Complete transcripts (1st year to final year) of obtained degree * ................................................. 1 copy
f. Certificate of language proficiency ............................................................................................... 1 copy
g. Enclosed recommendation letters (at least one from professor/lecturer
and other letters from supervisor/ professor/lecturer. please fill in the given form) .................... 1 copy
h. Motivation letter ........................................................................................................................... 1 copy
i. Additional documents required by scholarship application

* All submitted documents must be certified copies.


If this is a re-registration, please submit only the updated documents.

6 Applicant’s Declaration

I declare that all information provided is true, complete and accurate to the best of my belief and knowledge, and
that I have not willfully suppressed any material fact.

Signature: ____________________________ Place: _______________________, Date: ___ / ___ / 2020

THE COMPLETED APPLICATION FORM AND THE REQUIRED DOCUMENTS MUST BE SENT TO
GRADUATE SCHOOL OF ITC

A single pdf file (except the recommendation letters) via Email


and then a hard copy to our mailbox

Deadline: August 31, 2020


Incomplete applications are inadmissible.

Email: [email protected]
Mailbox: Room B-110, P.O.BOX 86, Russian Federation Boulevard, Phnom Penh, Cambodia

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