F.No. 30- r/20 r 9-8S.3 Govemment oflndia Ministry of Human Resource Development Depanment of Higher Education Division tr.c,,/Al,C. West Block-t, Wing - 6, 2"d Floor, R.K. puram, il, New Delhi- I 10065 To, Dated 09rh August 2019 The Chairman, All Ind ia NelsoD Vasant Kunj, New Delhi- I 10070 Subject: Chulabhorn Craduate lnstitute post- raduate Scholarship program for Year 2020 regarding the Academic Sir, I am directed to say lhal rhe Chulabhom U luate Institute, Bangkok, Thailand is scholarships ro Non,ASEAN offering l0 applicants for the Acad mic Year 2020 under the .Chulabhorn lnstirule Graduate Post-Craduare Scholarship program. in Ap ied Biological Sciences: Environmental Health. En\ ironmental Toxicology and Chemical-science 2. The Public Notice in rhis regard has already en displayed on the Ministry,s same is enclosed. website and the It is requested that the public notice sy be displayed on the AICTE,s website. also arraDge for further Kindlv disseminatioD ofthis ofler for i wide publicity. Yours faithfully. Encl: As above )+t'q { Visrlakshi Jayaranian ) Undersecretary (Scholarships) Tetet26t729t1 >-"- (ea) Xt \bF j a ru) ) CIIUI-AIJI]OIIN ROYAI, ACADBN1Y Chulrbhorn (;rndu.n( lnniru( Ch ulabhorn Graduate Institute post_graduate Scholarship Program for NON-ASEAN Applicants (Acadenric year 2020) Tl)c Chulabhonr Craduate Iustilutc (CCl) is a nrultjdisciplinary posl-graduate acadcD)ic institute csrablishcd in 2005, under rhe ioitiative of protlssor'Dr. HJ: noyar Uigrncss Ptinccss Chulabhorn lvlahidol_ Thc aim of CCI is to employ th" *ust ,e."nt inr.ractiu" teaching tcchniques used in leadirg cducational and rescarch institutions to p;;luce eflaclivc thirkers and Ieaders to better servc thcir countries' needs lowards sustainatle developmcDl. The CCI is preseDtly offcring progmrns teading to Masrer,s and OoctoJ Oegrec in apptica Biological .l-oxicology, _and Scicnccs: Environmental Hcallh, Envirorunenla) Cl:enrical Sc,ence. This ycar, (tcn) scholarships l0 arc availablc lor NON_ASEAN intcm&tional applicanls r() a Mastq's fursuc l)egrcc study at thc CCL Selection ofapplicants will be based o mcni. l!ligibilit_v Scholorships arc opcn to thc ctigiblc applicnnrs u,ho nrccr thc lbllowing qualificalions: l) Undcr 30 yoars ofagc 2J Hold a Bachelor Dcgrec rvilh a cunrularive GpA ofal least j.00 iD onc ofthc ibllowing fields: o Scicnces: Clremistry. Biological. Biological Soiences, Molecular Biology.. Eoviron entalScier)ccs o Nledical Sciences: Medicine. Mcdical l eclDology o Phafiracy or Phannacculical Scicnccs Applicants from othcr relalc(l ficlds rc tlso \.r,elconre to tpply. l) Havc expcricncc iu scic[tilic labolalory rcsearch .ll N4usl have dcmo strated linglish prolicicncy. prclerablv on onc of two recognizcd lcst ol lar)guagc proficicncy (TOEFI-- ll:LTS) 5t illust provide a statencnt ofpurposc explaining their intcrcsts in the study Supporting Document Ijollo$ing documents |iusl bc subniLltcd togothcr wilh applicalioD fbrm: l) Full Acadenic Transcript li l hrcc Ru:onrrncndrtion l-crtcrs j ) Staternent of Prupose c)iplaining intcrest of study 4) N.{cdicnl His(ory l{cpon 5)Othcr supporrirrg doculrents lo lacililate applicirtion screenillg Applicrtion Period Applications for the CGI Post,graduatc Schola$hip program are due on 30 Octollcr 2019 Notification of thc Aryrrd Successful applicants \vill bc norif-rcd ol tlre outconre by tlrc CCI around January 2020. Application Form CCI scholarship application fbnn and medical history report can be fcrund as thc attaclrrrenrs lior more infornratiort, pleasc contact Address: 'fhe Chulabhonl Graduarc hslitutc 54 Kamphargplrct 6 Road,'fal t Bang KIcn. l,aksi, Bangkok I0210 TllAll.ANt) E-mail: [email protected] lvcbsite: wv'\r.cgi-ac.th TclNos: (662) 554 )900ext. II55.2I.l0 lxr Nos: (66 2) 554-1990/ 554-1992 .a I'lace .,: l']hotograph -. ", l./\.J ,/ l-l ere (,ttUt,At ltoilN ((lYAl.4(iAl)F:l\lY Chulabhorn Graduate lnstitute Post-Graduate Scholarship program Scholarship Application Form (For NON-ASEAN Appticants) IMPORTANT INSTRUCTTONS: . Each question lnust bc atrswcred clearly ard completely. Duly cornpleted applicarion fbrms should be fonvarded to rhe Chulabhom Cftduare lnstitute before deadlille of applicarion . lpcomplctc spDlicltions will not be co[sidcred. Proposed field ofstudy: n Applied Biological ScieDces: Environme lal Lleatlh D Envirorlneoral loxicology E Chemical Sciences PIIISONT\I, DA'I'A 'l'itle l'an ly nanrc / Srrnarrrc Firs^t uxfitc ts sho\![ in C] tvlr. Maie ! tvtn. Femalc D u.. Ciry.nd counrry ofbinh D.t. oIAidh COIlIN,II.JNICT\'I'ION AND JVIAII,INC ADDIITiSS ,Appl icanr's Ol'lice Addrcss: Applicart's llonrc Address: orfice rclcphooc NO: I FAX: lldnc Ielephorc NO: I:AX Cou,,rr!1,\r(.i Nu'nbcr I Lou rearN fibcr L (ounrry ArcalNuir)bcr Cou 0lllcc Email Pcrsonal l:mailr Namc tnd address ol person lo be noliljo{l in c(se ofeDergency: 'felephone No: Relationship: lntcrnalionirl Airport / City ofDcpal1ure EDUCA'l'lON RIICORD Fiucarion hsirul aili/ Degrcas, Diplomas Mrjor ficld -lo CoLrntry GPA ffi yot, db"* ;il;ilill"iG;dt l,r".r,Mt ..**r,here and ror how lons? L,.*r .,lyour publi.rri.trrs/rcscil(h(s td,' rrul allc(h dclrrls) IiillPI-OYI\,! IlN t tutcOlll) l\ c".,ut ur nrost r.ec",,t Ycars ol s",vicclI.,,rr-ioy Ycars ol scrvicc (tionr-toI Title of your. pos?posirion f irle oIyouipoVposiGn 'Iyp" of youioiganizuri.*, l'ype of your organization: Cov.ntnrept/ Sepr CovernDreDr/ Itivarc/ NCO C!I9q.IS!y&!r!9v9mme''u priv;,rc/ NLi(, Nlain funcrion ot rhc ofnn iiorr lvlain function oIthc o.gonir^tiotl: -- otrrc-e"JiGi---- Office address: Descrip-tion of your rvs.k incluaingl6utc.pi ibiliii;jFiAffi;ii-nue ofiuppiiimenr,ry p6gcs if necessary) EXPECTA f IOr.'s rterrse aesiriucitre pracric@,.,,,,,-, the rcsponsihilitics you cxpcct to . assumc i nd thc condiriou cxisting iu your olol.vorrr your training.rr,;hi.. /Dr^.-., - couDtry in thc fickl tplcasc conrinue^^_,:_... on suppler,r."i",, ,r_". ,ir*".t*ri LANGUAGES (No considcra(ior will bc Siven to pplicants wirhour language proficiency rcsr documelts) English Proficicncy 1'cst* (plcase a[ach) EroEr,. r"u," E ,urr, ,"0.. E orher lspccifyy + Required ln[ornation Pagc 4 of 5 pages SUPPOR].rNC DOCI.'MENTS Transcripr E 1s) lJ Lerrcr of I.(ccounrcrxtarion rirlc institution/colrpany tit lc insritutiorVcomjany r illc insritrrrioVcompa[ L] N,tedicat Certifi care f] Orhers (ptease specify) Pleqsc rerd the following urd $igt I understand that withholding pcrrinent intbnnorion requcsted ir &is applicarion fonn or ,n(entionatly sivins false informarion wiu m"k. ,"" o";;n;i;;ji;l;"iiit," ii. considerario, I hcrcby ccrlify ,ir,,*,., lhal m_v cducalron and quarificatioDs are in admissirrn rcquirem ---"'*'accordancc wrlh the rs antl all rnlirrnrarion givcl rn rllis form is rtu; Applicanl's Signarure Dale Duly coD)pldcd applicalior i'olr should be lbrwarded io: The Chulabhorn Gradualc Insli(ulc 906 Kanrphar)gphct 6 ttond, I-alat Bang Khen, Laksi, Bangkok t 02 t0 .TIIAII-AND Ermril: cqi acadcnricrlltcei.ac.lir Ur.lylfyagl4& l'ago 5 of5 pagcs UlollLtultollafiL8spoll Nxnlr ol Nonlince - (i)[ntiv...... "n go """" *l'hysical Uxanrilation (.Ib l)c filtcd in bI physician) Prcsent Status IlciSht Cnrs. Weight kgs. Illood l,ressurc urn.llg. putsc /rnin Vision ltighr t cti wirh glasscs Milhout grxsses a) Do ),{)u cLrn.entry Lrse nny drugs fo, rhelreatnrcnl ol a nledical condilion? (givc na,nc ard rlosagc) ( ) No ( ) Yes : narnc ofnretlicatiol ( )' Quanlily ( b) A,e you pregnanr.? ) ( )No ( )Ycs: ( rno rhs) c) Arc you allcrgjo to any rncdicario) or lbod? ( )No ( ( )Ycs i )Medicalio i( ) Foo(t :( ) Orh(jr: Slr)ol c\antinfltioD fol.parasite & ()y Chcsr X - Ray reporl Urinc prcenitnc\ tcst .. Iricld of Study . Applied Biological Sciunocli: Ellvironmcntal llcllth . Environnrcntal.lb\icology . Chernical Scicnces Scholarship Coverage The scholarship rvill covcr and othcr aoademic fees. round h.ip airfare. accornnrodalio,, .tuilion .lonthry stipend, book allowa*cc- hcal$ ilsurancc ard othcrs_ Arvard Period Thc scholarship arvard will cover 6 wecks retiesher cours€s and follow by a penod of2 ycars :VIaster's Dcgree study, subject to an alrnual review ofthe sclrolar,s salislactory progrcss. No(c: Refreshel Courscs will tenlalively conrmel)ce in Junc 2020 \.r,lllc thc acadcn)ic prograrn lvill commcncc in Augusl2020. Application Procedure Applicants should conrplete the Chulabhom Craduate lnstitulc post _ Craduate scholiuship Program's application lbr.rr (tbr NON-ASEAN) ard sub ir rogother wirh orhcr supponinS documcflrs thrcugh lhe f-ollowing channel: ( I) Selld via c-majl thc scan file ofthe application lbrm and all the supporting docunrcnl to: Ihe Chulabholo Craduate Institure (CGI Scirolarship l,rogram) 54 Kamphangphct 6 Road, Talar Bang Khcn- taksi. Bangkok 10210 THATL ND Email: cgi acadclnic(a)cgi.ac.th (2)Alierstq)(I)scD(lalltheo ginal doculncnls via postal scryices to the address as stalcd ir: (r) Notc: No consideration will be givelr to irpplication with inco plete of supp(,fling docunrents- Cl,".k "."t, i;; i, ,;;;;r";r;; Itcnr Nornr:ll Abnoutlnl Addilio nl (otunle t Ccncr'al tr n SIin. ScirlD tr E l.rnph nodes E n I:!'cs tl tr l.]ills E E Oloscopic Or1lDr Nosc E n I'har'1,nx & tonsils tr D Tecrh tl E 'I'hyroid Sland fl E Lungs x E Ileafl T tl E n t"ivcr tl U Splecrr E D llcmit tl tl Ertcr'nal genitalia D tl Itcctal c)ianl E E E tl E E llcllcxes n tl Mc lal hcllth starus E E lsls rhethr norrrinccn.rlrlcr. ablc physicllllphysically and@rnd@ Islhellollrlllcrli,ccti,o,,'i',ti."ri".,*@utls ihe no.rilce jiec lio,; Illariasjs) turl olhcr conditions (such as psyclrosis an(i drug addictiorr) ,rliich,rliich-corlct corlci p.csenrp.cse risks lbl a ]ono dLu.ing the I-cllowship pcriocl? Docs lhc ,onrnec hav" rny.unai@ lblk>wship pcriod? Full nalne and address of Examining physician (prinred) Physician signaturc ......................._..........M.D.