Scholarship Application Form

Chulabhorn Graduate Institute

Post-Graduate Scholarship Application Form

(Only for International Applicants applying for Master Degree) — Academic Year 2027

Proposed Program of Study

Select one program only:

Applied Biological Sciences: Environmental Health

Chemical Sciences

Environmental Toxicology

Personal Data

Title

Family Name / Surname (as in passport)

First Name (as in passport)

Sex

City of Birth

Country of Birth

Nationality

Date of Birth

Marital Status

Religion

Photograph Passport-size photo (JPG/PNG, max 2MB)

Communication and Mailing Address

Applicant's Home Address

Applicant's Office Address

Home Telephone No. (Country|Area|Number)

Mobile Phone No. (Country|Area|Number)

Office Telephone No. (Country|Area|Number)

Personal Email Address

Office Email Address

Person to be notified in case of emergency:

Name & Address

Emergency Phone No.

Relationship

International Airport / City of Departure

Educational Record

Please list your educational background starting from undergraduate:

Name of University / Institution *

City *

Country *

From *

To *

Degree / Diploma *

Major Field of Study *

Cumulative GPA or Equivalent *

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

List of your publications / researches (do not attach)

Employment Record

Present or Most Recent Post:

Employer

Years (From)

Years (To)

Title / Position

Type of Organization

Main Function of Organization

Office Address

Previous Post:

Employer

Years (From)

Years (To)

Title / Position

Type of Organization

Main Function

Office Address

Description of your work including your responsibilities

Describe your scientific laboratory research experiences

Expectations

Please describe what you plan to do after you finished your study and return to your home country.

Languages

Consideration will be given to applications with language proficiency test documents only.

Language Proficiency

Language	Reading			Writing			Speaking
	Excellent	Good	Fair	Excellent	Good	Fair	Excellent	Good	Fair
Mother Tongue *
English *
Other

English Proficiency Test (A copy MUST be attached):

1) TOEFL Score

2) IELTS Score

3) Letter from university (English as medium of instruction)

4) Other (specify)

English Proficiency Proof (PDF, max 5MB)

Supporting Documents

Academic Transcript (Undergraduate or higher level only — PDF)

Medical Certificate (PDF) *

Letter of Recommendation (No standard format — 3 referees)

Referee 1

Name

Title

Institution / Company

Upload Recommendation Letter (PDF)

Referee 2

Name

Title

Institution / Company

Upload Recommendation Letter (PDF)

Referee 3

Name

Title

Institution / Company

Upload Recommendation Letter (PDF)

Statement of Purpose

Statement of Purpose (Please describe your motivation, research interests, and career goals)

How do you learn about this scholarship?

Please select. (You can choose more than one channel)

Institute's official website

Personal recommendation

Embassy in my country

Educational institution in my country

Other (please specify)

Declaration

I understand that withholding pertinent information requested in this application form or intentionally giving false information will make me automatically ineligible for application consideration. I hereby certify that my education and qualifications are in accordance with the requirements and all information given in this form is true.

I have read and agree to the above declaration *

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