Graduate School, Chulalongkorn University Attach 1

Application Form for Combined Scholarship for International Graduate Students inch
for Academic Year ………, Semester  1st  2nd
Photo
Please fill in the form with clear handwriting/typing or 
Apply for scholarship:
 (PhD) H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship
 (PhD) H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship + Top-up scholarship
 (Master) H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship
 (Master) H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship + Top-up scholarship
 Scholarship of the Faculty/Program ………………………………………………………………… + Top-up scholarship
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 ……......................................................................................................... ( First, Middle and Last name)

Date of Birth: ........................................................................... (Date/Month/Year) Age..............................Years
Nationality: ………………………….. Passport Number: ....................................................................................
2. Current address: …................................................................................................…..............................................
…….............…...…............................…..............................................…….............…...…...................................
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 ...........……………….....
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…............
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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.
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7. Are you applying for financial aid from government or other international organizations? If so, please give
details.
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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).

......................................................................................................................................................................................
......................................................................................................................................................................................
......................................................................................................................................................................................

10. Proposed plan of study or research (Write in detail)

......................................................................................................................................................................................
......................................................................................................................................................................................
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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

The Department/Program recommends ……………………………………….……………………………… for

 (PhD) H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship
 (PhD) H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship + Top-up scholarship
 (Master) H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship
 (Master) H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship + Top-up scholarship
 Scholarship of the Faculty/Program ………………………………………………………………… + Top-up scholarship

……………………………………………………………...…………............................…………………..............

…………………………………………………………………………............................………………….............

……………………………………………………………………....................................…………………..............

......................……….................... 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 the following scholarship
 (PhD) H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship
 (PhD) H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship + Top-up scholarship
 (Master) H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship
 (Master) H.M. the King Bhumibhol Adulyadej’s 72nd Birthday Anniversary Scholarship + Top-up scholarship
 Scholarship of the Faculty/Program ………………………………………………………………… + Top-up scholarship
In the case of 72th King’s Birthday+top-up or the Faculty+top-up, the 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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 Full Scholarship  Top-Up Scholarship+ King’s 72nd Birthday Ann. (PhD only)
Expenses
(PhD only) King’s 72nd Top-Up
● Rate of Thai Student-
Tuition Fees Support by Graduate School Rate of Thai Student- Differential Part-
Rate of Non-Thai Student ● Differential Part- Support by Graduate School Support by Faculty/Program
Support by Faculty/Program
Stipend 9000 Baht Support by 1500 Baht Support by
Support by Graduate School
10,500 THB/month Graduate School Graduate School
Transportation for ASEAN
recipient (Round Trip) with
Support by Graduate School - Support by Graduate School
actual payment in economy
class
Accommodation
5,500 THB/month for 50:50 Support by Graduate
Support by Graduate School -
ASEAN recipient (stay at School and Faculty/Program
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 Overseas Student-
Rate of Non-Thai Support by Graduate Support by Support by -
Student School Faculty/Program Faculty/Program
Stipend 7,000 Baht Support by 3,500 Baht Support 5,000 Baht Support by 5,500 Baht Support by
10,500 THB/month Graduate School by Graduate School Faculty/Program Graduate School
Transportation for
ASEAN recipient
Support by Graduate Support by Graduate
(Round Trip) with - -
School School
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.