APPLICATION FORM for Thailand International Postgraduate Programme: TIPP

INSTRUCTIONS

This application form is composed of five parts. Part A to part E should be completed in triplicate, part A to part D should be completed by the candidate and part E by the government authority. All application forms must be filled in typewritten form. Each question must be answered clearly and completely. Detailed answers are required in order to make the most appropriate arrangements. The National Focal Point for International Development Cooperation of the nominating Government will forward one original and two copies of certified application form and other related documents to the Thailand International Cooperation Agency (TICA), the Government Complex, Building B (South Zone), 8^th Floor, Chaengwatta Road, Laksi District, Bangkok 10210, THAILAND, through the Royal Thai Embassy/Permanent Mission of Thailand to the United Nations/Royal Thai Consulate – General accredited to eligible countries/territories.
The candidate is required to attach medical report or health status certification.
No consideration will be given to the late submissions or incomplete applications/documents

Course Name

Institute

Text Input

A. PERSONAL HISTORY

Title

Mr.

Mrs.

Ms.

Others

Family name

Middle Name

Given Name

Address

City

Country

Nationality

Date of birth (DD/MM/YY)

Age

Religion

Marital Status

Work Address

(Please complete this section as clear as possible, information will be used for travel arrangements.)

Fax No: (Country Code / Area Code/ Number)

Telephone No :

Home Address

(Please complete this section as clear as possible, information will be used for travel arrangements.)

Telephone No :

Email :

Fax No :

International Airport/City for departure :

Name and address of person to be notified in case of emergency :

Telephone No :

Relationship of this person to you :

Languages:

English

English Proficiency Test

(please attach) (only a candidate for a degree course)

TOEFL

IELTs

Other (specify)

Education Record:

Education Institution

City / Country

Years Attended

Degrees, Diplomas and Certificates

Special fields of study

Have you ever been trained/studied in Thailand? If yes, what course, where and for how long?

Please give a list of relevant publications/researches

Are you currently applying for scholarship (s) from other source (s)?

B. EMPLOYMENT RECORD

(It is important to give complete information. For each post you have occupied, give details of your duties and responsibilities.)

Present or most recent post & Previous post : :

Date

Title of your post:

Name of organisation:

Ministry

Type of organisation:

Official address:

Description of your work, including your personal responsibilities

C. REFERENCES

(Please attach the recommendation letters from three (3) persons acquainted with your academic and professional experiences.)

D. EXPECTATIONS

Please describe the practical use you will make of this training/study on your return home in relation to the responsibilities you expect to assume and the conditions existing in your country in the field of your training.

I certify that my statements in answer to the foregoing questions are true, complete and correct.

If accepted for a scholarship award, I undertake to:

carry out such instructions and abide by such conditions as stipulated by both the nominating government and the host government in respect of this programme of scholarship;
follow the programme of scholarship, and abide by the rules of the University and Thailand International Cooperation Agency in which I undertake the scholarship;
refrain from engaging in political activities, or any form of employment for profit or gain;
study full time, make academic progress and submit progress reports to Thailand International Cooperation Agency;
not bring any member of my family to stay with me during the course;
return to my home country promptly upon the completion of my programme of scholarship.

I also fully understand that if I am granted a scholarship award and violate Thailand International Cooperation Agency’s rules and regulations, I may be required to return part or all of the scholarship paid, depending on the severity of the violation, without any appeal.

Signature of candidate:

Printed name:

Date