SCHOLARSHIP APPLICATION FORM

Transcription

1 SCHOLARSHIP APPLICATION FORM Instruction 1) Please ensure that you have read the Announcement of Walailak University on the Ph.D. Scholarship for Outstanding International Students and the Application Guidelines before completing this form. 2) Complete this form by typing in English only. 3) Return your application form and all required supporting documents to your prospective thesis advisor. Incomplete applications shall not be considered. 1. PERSONAL DETAILS Full name Title Mr. Miss Ms. Mrs. Sex Male Female Date of Birth Passport No. Mobile Age Religion (Please include country and area codes) Nationality Country of Permanent Residence Permanent Address Currently Mailing Address Address Line 1 Address Line 1 Address Line 2 Address Line 2 City Province/State Postcode Country City Province/State Postcode Country 2. PROSPECTIVE PH.D. PROGRAM Before applying for this scholarship, a candidate must receive an offer letter from the proposed Ph.D. Program. Program School Thesis Advisor Proposal Title Expect to start in Academic Year Term Study Plan Plan 1.1 Candidate with a Master s degree, must take at least 90 credits for thesis Plan 1.2 Candidate with a Bachelor s degree, must take at least 60 credits for thesis 1

2 3. EDUCATIONAL QUALIFICATIONS Please attach a separate list (by using the above format) if you have additional educational qualifications. 4. ENGLISH LANGUAGE PROFICIENCY 4.1 Are you a native English speaker? Yes No If no, your native language is 4.2 Did you gain your Bachelor s from a native English speaking country? Yes No I gained my Bachelor s from If your answers are NO for both 4.1 and 4.2, you are required to submit IELTS (Academic test) or TOEFL Score which meets our requirements as per the below table. Please be noted that IETLS and TOEFL scores are valid for only 2 years after the test date. Test Type Required score Your Score Test Date TOEFL PBT At least 500 TOEFL CBT At least 173 TOEFL IBT At least 61 IELTS - Academic Test only At least 6.0 2

3 5. SCHOLARSHIPS, AWARDS AND PUBLICATIONS PH.D. SCHOLARSHIP Scholarships/Awards Scholarships/Awards Country Year Awarded Publications Author(s) Publication title Publisher/Journal Title Language of Publication DOI Year of Publication Author(s) Publication title Publisher/Journal Title Language of Publication DOI Year of Publication Please attach a separate list (by using the above format) if you have additional scholarships, awards and publications. 3

4 6. EMPLOYMENT HISTORY Please provide details of employment beginning with your current or most recent employment Job Title Employer Name Country Employment Duration (mm/yyyy) Start End 7. REFEREES REFEREE NO. 1 Full name with title Position Organization Relationship Phone REFEREE NO. 2 Full name with title Position Organization Relationship Phone 4

5 8. SUPPORTING DOCUMENTS CHECKLIST All supporting documents must be sorted as the below order and combines into one electronic file (.pdf) and sent it to the scholarship secretariat at Application Form Personal Statement Research Proposal Resume A copy of Bachelor's Transcript A copy of Master s Transcript A copy of Bachelor's Graduation Certificate A copy of Master's Graduation Certificate A copy of TOEFL/IELTS Score Report A copy of Passport s Master Page Miscellaneous supporting documents, as the detail below; 9. DECLARATION I declare that I have read and understood the scholarship details stated in the Announcement of Walailak University on the Ph.D. Scholarship for Outstanding International Students. All statements provided by me in connection with this application are true, accurate and complete. I am fully aware that Walailak University reserves the right to refuse admission or to revoke a scholarship of any candidates whose statements and supporting documents are found to be false or counterfeit. Signature Date (dd/mm/yyyy) By typing your name into this box, it is considered that you have signed this form and all the information is true and correct. (An electronic signature is not required) 5