(ASEAN University Network / Southeast Asia Engineering Education Development Network)

APPLICATION FORM for AUN/SEED-Net Scholarship

Masters Degree Program 2012

Application form can be downloaded from http://www.seed-net.org/ and can be photocopied as needed. Please print or type all entries. The original and all required documents should be submitted by post, through Member Institutions where the applicant belong, at the below address: AUN/SEED-Net Project (Masters Degree Program) Tel: (66 2) 2186419, 2186420, Faculty of Engineering Bld 2, Rm 109-110 2186421 Chulalongkorn University Fax: (66 2) 2186418 Bangkok 10330, THAILAND E-mail: grad@aun-seed.net

Photo
(Taken within the past 6 months)

Program Guidelines
Applicants should carefully study the Implementation Guidelines of the Masters Degree Program 2012. It is advisable to provide detailed information and description for each item below, and attach supporting documents when necessary.

1
1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9

Personal Information (I)

Family Name Given Name(s) Full Name (as appeared in passport) Nationality Date of Birth Age Gender (please mark ) Current Status/Position Department/Faculty University/Organization

Date Male

Month Female

Year (not over 30 at the time of application)

2
2.1 2.2

Personal Information (II)

Marital Status Office Address Tel / Fax / Mobile E-mail Address Home Address Single Married

2.3

Tel / Fax When communication with applicants is needed, AUN/SEED-Net will contact mainly to your Sending Institution and/or to your e-mail address. Please make sure you keep regular contact with your institution and/or access to your given e-mail address. In case you do not have an e-mail address, please specify your preferred contact address below. 2.4 E-mail Office Home AUN/SEED-Net Masters Degree Program 2012

Preferred Contact Address (please mark at your preference)

Other (Please give full details)

Academic Qualifications

A certified official certificate and transcript (with grade points) issued by the university and a certified letter of class rank signed by Dean or Registrar must be submitted with this application form. For graduating students, an official transcript with academic record up to the time of application must be submitted as an alternative. 3.1 Bachelors Degree 3.2 Program/Faculty 3.3 University 3.4 Date of Completion (or expected to) Month Year 3.5 Grade Point Average of all semesters taken (Honors, if any) 3.6 Class Rank Placed at the rank of (Please submit a Out of the total number of students of certified letter) In the Department/Program of

Relevant Qualifications

Any honors, distinction, or certificate obtained in your academic career that is not indicated in the official statement should be mentioned in a separate statement. Relevant document should be attached to support your information stated below. 4.1 English Language TOEFL Date taken GRE Date taken Others (Please specify) 4.2 Other Awards, Honors, Certificates (Please give details)

Employment Record

Please summarize (in separate sheet) any employment experience, including name of employer, your position, job responsibility and period of work

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6.1

Proposed Graduate Program

Proposed Place of Study (1) First Priority Applicants can apply to the maximum of two Host Institutions, but cannot apply to any institution within their own country. If you wish to apply to two universities, please ensure you attach the applications of both universities. University Department Field of Study Preferred advisor (if any) Semester Month Year University Department Field of Study Preferred advisor (if any) Semester Month Year AUN/SEED-Net Graduate Program covers 9 fundamental fields, from which you can choose at the time of application to study at the Host Institution responsible for the respective field. However, in terms of research, apart from research topics AUN/SEED-Net Masters Degree Program 2012; p.2/13

(2) Second Priority

6.2

Propose Research Area or Topic

under fundamental fields, student can also choose to do research across fields. Please check () if you are interested in any of the following research areas listed below; Fundamental Fields Interdisciplinary research areas: Biotechnology Disaster Mitigation Global Environment Natural Resources/Materials New/Renewable Energy (For further details regarding each interdisciplinary research area, please feel free to visit http://www.seed-net.org/research_umbrella.php)

Medical Record

Please acquire a medical certificate from a licensed doctor and submit it with this application. The certificate must cover your health condition showing that you have sufficient ability to complete a graduate study abroad.

Document Checklist : Compulsory

Please check () that your application is complete and that you have enclosed all documents listed below. These documents are compulsory and please note that AUN/SEED-Net Project reserves its right NOT to consider any application with incomplete documents. A. Application of AUN/SEED-Net (for scholarship) 8.1 This application form, completed with photo & signature 8.2 Official Bachelors Degree certificate (original or certified copy) 8.3 Official Bachelors transcript with grade points (original or certified copy) 8.4 Certified letter of Class Rank of the Bachelors study from the Dean or Registrar Office of your graduated institution (Form in Attachment 4) 8.5 Medical check-up certificate by a licensed doctor 8.6 At least one Letter of Recommendation from the Dean or Head of the Department to which you belong or from which you graduated. (Form in Attachment 5) 8.7 Letter of Endorsement from the Rector or Dean of Member Institution to which you belong (with current status or position in case you are a faculty staff.) B. Application of Host Institution(s) (for university admission) 8.8 Two sets of completed application(s) of the Host Institution(s) with photo & signature, and all documents required by the Host Institution(s) for which you want to apply (Please note that each host may have different requirements.)

Document Checklist : Optional

Please check () if you have enclosed the documents listed below. These documents are not compulsory but may help support your qualifications. 9. Notifying letter of admission from Host Institution(s) from which you want to apply (only in case you 1 have earlier applied to a Host Institution and already been admitted) 9. Certificate of English proficiency, e.g. TOEFL official score 2 9. Others (please specify): 3

AUN/SEED-Net Masters Degree Program 2012; p.3/13

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Declaration

I declare that all information supplied in this application as well as the attached documents are true and correct to the best of my knowledge. I acknowledge that the provision of incorrect information or supporting documents may result in termination of scholarship, and that I will have to be responsible for all expenses incurred from my misinformation. If awarded the scholarship, I agree:

(a) to abide by the rules and regulations of the Host Institution, AUN/SEED-Net Project, and JICA; (b) to follow course regulations and instructions and abide by such conditions as may be stipulated by both the
host institution and the AUN/SEED-Net in respect of this course of study; (c) to refrain from engaging in political activities, or any form of employment for profit; (d) to submit any progress reports or evaluation questionnaire which may be prescribed; (e) to return to my home country at the end of my course of study. I also fully understand that, the scholarship, if awarded, may be subsequently withdrawn for failure of making adequate progress, or for other sufficient cause including health condition as determined by AUN/SEED-Net. Signature: Date:

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Declaration for Graduating students or younger graduates only

I strongly wish to become a teaching staff or researcher at the Member Institution after my Masters study under the AUN/SEED-Net Project. Signature: Date:

AUN/SEED-Net Masters Degree Program 2012; p.4/13

ATTACHMENT 1 List of Host Fields, Host Institutions and Japanese Supporting Universities
1 2 3 4 5 6 7 8 9 Host Field Chemical Engineering (ChE) Environmental Engineering (EnvE) Manufacturing Engineering (ManuE) Materials Engineering (MatE) Civil Engineering (CE) Electrical & Electronics Engineering (EEE) Information & Communication Technology (ICT) Mechanical & Aeronautical Engineering (ME/AE) Geological Engineering (GeoE) Host Institution De La Salle University (DLSU) University of the PhilippinesDiliman (UP) University of Malaya (UM) Universiti Sains Malaysia (USM) Chulalongkorn University (CU) Chulalongkorn University (CU) King Mongkuts Institute of Technology, Ladkrabang (KMITL) Institut Teknologi Bandung (ITB(INA)) Gadjah Mada University (UGM) Host Country The Philippines The Philippines Malaysia Malaysia Thailand Thailand Thailand Indonesia Indonesia

Applicants who are interested in any of the interdisciplinary areas i.e., Biotechnology, Disaster Mitigation, Global Environment, Natural Resources/Materials, and New/Renewable Energy can apply to any of the above Host Institution, depending on research focus. For the applicants convenience, the web-sites of the Host Institutions can be accessed from the AUN/SEED-Nets web-site (www.seed-net.org), where application forms of most universities can be downloaded. The following is the list of 11 Japanese Supporting Universities. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Hokkaido University Keio University Kyoto University Kyushu University National Graduate Institute for Policy Studies Tokai University Tokyo Institute of Technology Toyohashi University of Technology University of Tokyo Shibaura Institute of Technology Waseda University

AUN/SEED-Net Masters Degree Program 2012; p.5/13

ATTACHMENT 2

A pplica tio n a nd S c re e ning Pro c e dure o f A U N /S E E D -N e t M a s te r's D e g re e Pro g ra m 2 0 1 2

Ho s t In s titu tio n (H I)
HI a p p l i c a ti o n

(3 ) S E E D -N e t c h e c k s e lig ib ility o f a p p lic a n ts a n d fo rw a rd s H I a p p lic a tio n s to re s p e c tive H Is A U N /S EED-Ne t (S EED-N e t)

(4 ) H I c o n d u c ts a d m is s io n s c re e n in g a n d s e n d s H I a d m is s io n re s u lt to a d m i ssi o n re su l t S E E D -N e t in p rio rity o rd e r

HI a p p l i c a ti o n

(2 ) C o n ta c t p e rs o n a t S I SE ED et -N c h e c k s a p p lic a tio n a p p l i c a ti o n d o c u m e n ts a n d E n d o r se m e n t fo rw a rd s th e m (in b u lk ) f ro m S I to S E E D -N e t w ith e n d o rs e m e n t fro m S I S e n d in g In s titu tio n (S I)

(5 ) S E E D -N e t c o n d u c ts s c h o la rs h ip s c re e n in g S -N o f th o s e a d m itte d b y HEI E D e t sc h o l a rsh i p a n d a n n o u n c e s th e re su l t s c h o la rs h ip re s u lt to re s p e c tive S Is

HI a p p l i c a ti o n SE E D et -N a p p l i c a ti o n

(1 ) E a c h a p p lic a n t s u b m its S E E D -N e t a p p lic a tio n a n d 2 s e ts o f H I a p p lic a tio n (s ) to C o n ta c t P e rs o n a t S I A p p lic a n t

(6 ) S I in fo rm s th e re s u lt to e a c h s u c c e s s fu l a p p lic a n t a n d e n d o rs S EsE D e t e -N sc h o l a rsh i p th e R e p ly F o rm re su l t

AUN/SEED-Net Masters Degree Program 2012; p.6/13

ATTACHMENT 3
List of Contact Persons at Member Institutions for AUN/SEED-Net Graduate Degree Study Program 2012

No. 1

MI. ITC

As Sending

Contact Person Dr. Thavarith Chunhieng (cc: Dr. Romny OM ) Prof. Dr. Boualinh Soysouvanh

Position Deputy-Director General Director General Dean, Faculty of Engineering Vice Dean, Faculty of Engineering Coordinator

Email Address fc@itc.edu.kh thavarit@itc.edu.kh (cc: romny@itc.edu.kh) boualins@fe-nuol.edu.la kphoui@etllao.com

NUOL

Sending

Assoc. Prof. Dr. Khamphoui Southisombath Ms. Pipong Phimphachanh Prof. Dr. Tin Tun

ppipongp@yahoo.com uycontact.mm@gmail.com Tel: (95-01) 514908 Fax: (95-01) 510721 uycontact.mm@gmail.com (cc: MiMiCho.MY@jica.go.jp Tel: (95-1) 255473-6 Fax: (95-1) 255477 ytu.rector@gmail.com Tel: (95-01) 651717, 650762, 660720 Fax: (95-01) 642564 (cc: ytu.rector@gmail.com Tel: (95-1) 642557 Fax: (95-1) 642564 (cc: MiMiCho.MY@jica.go.jp Tel: (95-1) 255473-6 Fax: (95-1) 255477 doantrang@mail.hut.edu.vn Tel: (84-4) 868 3197 Fax: (84-4) 869 6720 (cc: HXLAN@mail.hut.edu.vn)

Rector

UY

Sending

(cc: Dr. Aye Aye Thant) (cc: Ms. Mi Mi Cho)

Associate Professor, Physics Department JICA Myanmar Office

Prof. Dr. Mya Mya Oo

Rector

YTU

Sending

(cc: Mr. Khin Maung Zaw)

Department of Foreign Relations Yangon Technological University JICA Myanmar Office International Cooperation Department

(cc: Ms. Mi Mi Cho) Ms. Doan Thi Thu Trang 5 HUST Sending (cc: Mr. Hoang Xuan Lan) Ms. Nguyen Thi Pho 6 HCMUT Sending (cc: Assoc. Prof. Dr. Phan Dinh Tuan) 7 BUU Sending Dr. Anat Deepatana

External Relations Office Vice President Dean, Faculty of Engineering

ntpho@hcmut.edu.vn phonguyen1987@gmail.com Tel: (84-8) 38652442 (cc: pdtuan@hcmut.edu.vn phantuan23bhht@gmail.com) anat@eng.buu.ac.th Tel: (66-81) 983 6300

AUN/SEED-Net Masters Degree Program 2012; p.7/13

KMITL

Sending & Hosting

Assoc. Prof. Dr. Anantawat Kunakorn (cc: Prof. Dr. Pakorn Watanachaturaporn. (cc: Ms. Arunee Suvarnatarn) Assoc. Prof. Dr. Boonsom Lerdhirunwong (cc: Ms. Jane Samonte) (cc: Ms. Nongcharosporn Pinkaew) Ms. Elizabeth L. Salazar (cc: Dr. Aura C. Matias) Prof. Dr. Pag-asa D. Gaspillo

Dean, International College, KMITL Assistant to Dean, International College International Relations Office Dean, Faculty of Engineering International School of Engineering Office Graduate Office of Engineering Dean, College of Engineering Dean, Collage of Engineering Director of the Engineering Graduate Studies Dean, Faculty of Industrial Technology Dean, Faculty of Mechanical and Aerospace Engineering Faculty of Mechanical & Aerospace Engineering International Cooperation Office, Faculty of Engineering Geological Engineering Department Head of Geological Department

kkananta@kmitl.ac.th (cc: pakorn@live.kmitl.ac.th) (cc: ksarunee@kmitl.ac.th) Tel: (66-2) 326 4729 boonsom.L@chula.ac.th (cc: ise@eng.chula.ac.th) elsalazar@up.edu.ph (cc: aura.matias@up.edu.ph) pag-asa.gaspillo@dlsu.edu.ph (cc:leonila.abella@dlsu.edu.ph) (cc: joseph.auresenia@dlsu.edu.ph) sasongko@fti.itb.ac.id sasongko@che.itb.ac.id aim@ms.itb.ac.id tdirgantara@ae.itb.ac.id

CU

Sending & Hosting

10

UP

Sending & Hosting

11

DLSU

Sending & Hosting

Sending 12 ITB Hosting

(cc: Prof. Dr. Leonila C. Abella) (cc: Prof. Dr. Joseph Auresenia) Assoc. Prof. Dr. Dwiwahju Sasongko Assoc. Prof. Dr. Andi Isra Mahyuddin Dr. Ir. Tatacipta Dirgantara

Sending

Ms. Aci Prima Sari Prof. Dr. Dwikorita Karnawati

uphi_ft@yahoo.com dwiko2007@yahoo.co.id sugengssurjono@gmail.com (cc: fnehendrastomo@gmail.com )

13

UGM Hosting

Dr. Sugeng Sapto Surjono (cc: Ms. Fransisca N. Herdrastomo)

Sending 14 USM Hosting

Ms. Farah Binti Man Prof. Dr. Ahmad Fauzi Mohd Noor Dr. Shatirah Mohamed Akib Mr. Aznijar Bin Ahmad Yazid

Assistant Registrar Dean, School of Materials & Mineral Resources Engineering Department of Civil Engineering Department of Engineering Design and Manufacture

norpisah@notes.usm.my Tel : (60-4) 653-2774 afauzi@eng.usm.my shatirah@um.edu.my shatirahakib@yahoo.co.uk aznijar@um.edu.my

Sending 15 UM Hosting

AUN/SEED-Net Masters Degree Program 2012; p.8/13

ATTACHMENT 4

Certified letter on academic standing

To Whom It May Concern: This is to certify that .. is / was placed at the rank of . out of the class of students in the department / program of ., Faculty of .. at ..

Signature ............................................................. Name in print ...................................................... Position ............................................................... Institution ............................................................ Date .....................................................................

AUN/SEED-Net Masters Degree Program 2012; p.9/13

ATTACHMENT 5

LETTER OF RECOMMENDATION
This form must be completed, put into a separate envelop, sealed, and signed right on the seal by the referee him/herself, otherwise the recommendation will be invalid.) This part is to be completed by applicant. Full Name: __________________________________________________________________________ Proposed Program of Study 1. 2. Place of Study Place of Study ______________________________________________________________ ______________________________________________________________ Program applying ______________________________________________________________ Program applying ______________________________________________________________

TO THE PERSON EVALUATING THE APPLICANT: The person whose name appears above is applying for the Graduate Degree Program of the AUN/SEEDNet. AUN/SEED-Net requires your submission of the completed Letter of Recommendation as part of our appraisal of the above-named applicant. We realize that considerable time and effort are needed to respond to this request. Your assistance is therefore greatly appreciated.

This part is to be completed by the person completing this Letter of Recommendation Form. Full Name: ________________________________________________________________________ Position / Title: _____________________________________________________________________ Organization: ______________________________________________________________________ Contact Address: ___________________________________________________________________ ___________________________________________________________________ Tel: ____________________________________ Fax: _____________________________________ Mobile: _________________________________ E-mail: ___________________________________ 1. (a) (b) (c) (d) What is your candid opinion of the applicants potential to complete the program applied intellectual capacity, promise of productive scholarship, and ability to carry out creativity and originality; relative standing among contemporary graduates; ability to pursue higher education for which the medium of instruction is English

for considering his/her: independent research;

AUN/SEED-Net Masters Degree Program 2012; p.10/13

________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ______________________________________________________________________ 2. Please cite outstanding qualities concerning his/her: (a) personality (maturity and ability to work with others); (b) communication skills ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ____________________________________________________________________________

3. Based on the above, how would you recommend the application for the Graduate Degree
Program of the AUN/SEED-Net? (Please mark below where appropriate) Strongly Recommend Recommend without reservation Recommend with some reservation Do not recommend Additional Comments: ________________________________________________________________________________________ ____________________________________________________________________________________ ______________________________________________________________________________________

Signature_____________________________________

Date_________________________________________
AUN/SEED-Net Masters Degree Program 2012; p.11/13

APPLICATION CHECKLIST
Please remember to include the following documents in your application: (Mark X in front of the documents submitted)

For AUN/SEED-Net
One set of completed AUN/SEED-Net application form with recent photo and signature(s) Required supporting documents (in English) Endorsement letter from your Sending Institution Official Bachelors Degree certificate Official Bachelors transcript with grade points Certified letter of Class Rank of the Bachelors study Medical check-up certificate Letter of Recommendation (if more than one, specify how many:) Letter of Endorsement from Rector or Dean Additional supporting documents (in English) Notifying letter of admission from Host Institution(s) Certificate of English proficiency Other(s), please specify . . .

For Host Institution 1 (please fill in the name):______________________

Two sets of completed application form of the Host Institution with recent photo & signature(s) Supporting documents (Please specify) . . . . . .

For Host Institution 2 (please fill in the name):______________________

Two sets of completed application form of the Host Institution with recent photo & signature(s) Supporting documents (Please specify) . . . .

AUN/SEED-Net Masters Degree Program 2012; p.12/13

AUN/SEED-Net Masters Degree Program 2012; p.13/13