Application for Graduate Admission

Chulabhorn Graduate Institute

Form App01 — Thai Applicants (Master / Doctoral Degree)

A. Application for Admission

1. Proposed field of study

Applied Biological Sciences: Environmental Health

Environmental Toxicology

Chemical Sciences

2. Degree / Level

Master (ปริญญาโท)

Doctoral (ปริญญาเอก)

3. Interview

Direct interview (at CGI)

On Zoom

B. Personal Information

1. Name & Surname

Title (คำนำหน้า)

First name in Thai (ชื่อ)

Surname in Thai (นามสกุล)

Title

First name in English

Surname in English

Sex

Date of birth

Blood group

ID Number (เลขประจำตัวประชาชน 13 หลัก)

Invalid ID number (checksum).

Copy of ID card (สำเนาบัตรประชาชน — PDF/JPG/PNG, max 5MB)

Place of birth (province / city)

Nationality

Marital status

Number of children

2. Mailing address (ที่อยู่ที่ติดต่อได้)

3. Permanent address (ที่อยู่ตามทะเบียนบ้าน)

Same as mailing address (เหมือนที่อยู่ที่ติดต่อได้)

4. Phone

Mobile phone

5. Email address

Photograph Photo taken within the past 12 months (JPG/PNG, max 5MB)

H. Emergency contact

Name

Relation

Mobile phone

C. Education Record

1. Education background

Bachelor (ปริญญาตรี) *

University / Institute

Degree title

Field of study

Year from

Year to

Currently studying

GPAX (cumulative GPA)

Country

City (optional)

Master (ปริญญาโท) — if applicable

University / Institute

Degree title

Field of study

Year from

Year to

Currently studying

GPAX (cumulative GPA)

Country

City (optional)

2. Thesis topic in Master's degree (if applicable)

3. Awards, scholarships and special achievements

Major publications (do not attach)

D. Employment Record

1. Current occupation / work (leave blank if not applicable)

Current occupation / Position

Department / Company

Division (กอง / ฝ่าย)

Ministry (กระทรวง)

Address

2. Employment history

Position

Organization / Place

From

Description of your work including your responsibilities (optional)

Describe your scientific laboratory research experiences (optional)

Expectations

Please describe what you plan to do after you finish your study.

E. English Language Proficiency

Please indicate which one(s) of the English language proficiency tests you have taken or plan to take. * at least one

Test	Date taken or to be taken	Score (if available)
TOEFL
IELTS
CU-TEP

Test result (PDF, max 5MB — if available)

F. Financial Support

Please indicate whether financial aid / scholarship from CGI is requested

Yes

G. Supporting Documents

Transcript(s) (Bachelor and higher — PDF, max 5MB)

Medical Certificate (PDF, max 5MB)

Letters of Recommendation * at least two

Please provide referee details. Letters may be uploaded here (PDF) or sent directly to CGI by the referee.

Referee 1

Name

Title

Institution / Company

Recommendation letter (PDF, optional)

Referee 2

Name

Title

Institution / Company

Recommendation letter (PDF, optional)

Referee 3 (optional)

Name

Title

Institution / Company

Recommendation letter (PDF, optional)

Others (PDF only, optional — max 5MB)

Statement of Purpose

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

How did you hear about this program?

Please select (you can choose more than one)

CGI official website

Social media (Facebook, LINE, etc.)

Personal recommendation

University / Workplace

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 admission to the Chulabhorn Graduate Institute and/or face immediate dismissal from the Institute. I hereby certify that my education and qualifications are in accordance with the admission requirements of the CGI and all information given in this form is true.

I have read and agree to the above declaration *

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