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We b Site,rvn'vv. crd.gov, I k Oodo a0od @o)Utlo0dtu0 6l ar oflp n u @ot en rnu a ehgfl co crur6 e sn tb Department of External Resources Qg@ q@ror:ocecr @oodls@ aor6o:go (3Ot6 OoO),tDE.oo. 27,oro>g$O0lC0, 6 Goo:O 6Sl arorLode Oou.ro;oo rs4rb ronr4r.g Qu. Stor ar. Qonqgdq ooroo,$olriroo rhe secrerariatrr,. rroo,il'llillr::!;;:::,"mbo 00 100, Sri Lan ka e-mail:infolbenl gcv.l( $ooJ qotso ocngtr$cu l,4y tlo f NTHlGenl2}21 OoO qooo a-o51$to Your No l €oo $a$ Date ) ) ) 11 February 2021 Secretaries/ All Ministries Secretaries I All State Ministries Chief Secretaries/ All Provincial Councils All Heads of Departments i lnstitutions Attn: Officer- in-charge of Foreign Training Dear Sir / Madam Scholarships for Masters Degrees under the Thailand lnternational Postgraduate Programme {TIPP} for the year 2A21 The Govemment of Thailand has invited nominations from etigible Government Officials in Sri Lanka for lhe following Masters programmes for the academic years 2021-2023 to be held in Thailand. Course details are given below for your informalion please. Duration 2 years 2021 - July 2023 2 years (June 2021- May 2023) File No Courses r^/rHlLloL/2071. Master of Science Program in Bioscience for Sustainable Agriculture 2 years (July 2021 - October 2023) 2 years (August 2021. - May 2023) 2 years (August 2021- May 2023) Master of Science in Pharmacy Program in Pharmaceutics Master of Science/Master of Engineering Program in Environmental Technology and Management TA/rHlLl03/2027 rA/rHlLla4/2a27 Master of Science Program in Smart Grid Technology 2 years (June 2021* May 2023) rAlrH/Llos1202L Master of Science Program in Food Science and Technology 2 years (August 2OZL - May 2023) rA/rnlLla6l2o2:- Master of Science Program in Food lnnovation, Safety, and Quality Managernent 2 years {.lune 2021- May 2023} T^lrHlL/O7 /2027 Master of Science Program in Agricultural Science Master of Science Prograrn in Agri-Science and Technology (Postha rvest) 1^/rH/LlA8/2021. r^lrHlL/oel2a2t Master of Science Program in Dermatology and Dermatosurgery q0irda dailid uauufluunenry gnu.retb Director Genrral oJLlorGrci s{sI6'u5'Del.b Office 9.1- I 1-2,18.1500 9'1- 11 .2.1B4(r00 l 'ffi4 qo{r(] 9{-t 1.24,r7633 9.r.t1":3{r7153 94- 11-2.1:r.t876 OStr.r|{uD&6i) lax i 94-11-2.18.1fi93 rA/7HlLl02/2027 2 years (June 2021 - Mav 2023) )
18

Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

Aug 02, 2021

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Page 1: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

We b Site,rvn'vv. crd.gov, I k

Oodo a0od @o)Utlo0dtu06l ar oflp n u @ot en rnu a ehgfl co crur6 e sn tb

Department of External Resources

Qg@ q@ror:ocecr

@oodls@ aor6o:go (3Ot6 OoO),tDE.oo. 27,oro>g$O0lC0, 6 Goo:O

6Sl arorLode

Oou.ro;oo rs4rb ronr4r.g Qu. Stor ar. Qonqgdq ooroo,$olriroo

rhe secrerariatrr,. rroo,il'llillr::!;;:::,"mbo 00 100, Sri Lan ka

e-mail:infolbenl gcv.l(

$ooJ qotso

ocngtr$cu

l,4y tlof NTHlGenl2}21

OoO qoooa-o51$to

Your No l€oo$a$Date

)))

11 February 2021

Secretaries/ All Ministries

Secretaries I All State Ministries

Chief Secretaries/ All Provincial Councils

All Heads of Departments i lnstitutions

Attn: Officer- in-charge of Foreign Training

Dear Sir / Madam

Scholarships for Masters Degrees under the Thailand lnternational Postgraduate Programme

{TIPP} for the year 2A21

The Govemment of Thailand has invited nominations from etigible Government Officials in Sri Lanka for

lhe following Masters programmes for the academic years 2021-2023 to be held in Thailand. Course

details are given below for your informalion please.

Duration

2 years

2021 - July 2023

2 years

(June 2021- May 2023)

File No Courses

r^/rHlLloL/2071. Master of Science Program in Bioscience for

Sustainable Agriculture

2 years

(July 2021 - October 2023)

2 years

(August 2021. - May 2023)

2 years

(August 2021- May 2023)

Master of Science in Pharmacy Program in

Pharmaceutics

Master of Science/Master of Engineering

Program in Environmental Technology and

Management

TA/rHlLl03/2027

rA/rHlLla4/2a27 Master of Science Program in Smart Grid

Technology

2 years

(June 2021* May 2023)

rAlrH/Llos1202L Master of Science Program in Food Science

and Technology

2 years

(August 2OZL - May 2023)

rA/rnlLla6l2o2:- Master of Science Program in Food lnnovation,

Safety, and Quality Managernent

2 years

{.lune 2021- May 2023}

T^lrHlL/O7 /2027 Master of Science Program in Agricultural

Science

Master of Science Prograrn in Agri-Science and

Technology (Postha rvest)

1^/rH/LlA8/2021.

r^lrHlL/oel2a2t Master of Science Program in Dermatology and

Dermatosurgery

q0irda dailiduauufluunenry gnu.retb

Director Genrral

oJLlorGrci

s{sI6'u5'Del.bOffice

9.1- I 1-2,18.1500

9'1- 11 .2.1B4(r00l'ffi4

qo{r(] 9{-t 1.24,r76339.r.t1":3{r715394- 11-2.1:r.t876

OStr.r|{uD&6i)

lax i94-11-2.18.1fi93

rA/7HlLl02/2027

2 years

(June 2021 - Mav 2023)

)

Page 2: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

1^/rHlL/11/2021 Master of Science Prograrn in Public Health 2 years

(June 2021- May 2023)

r A/TH/L/12/2A21. Master of Nursing Science 2 years

(July 2021 * June 2023)

rA/rH/Llt3/2021 Master of Science in Pharmacy Program in

Clinical Pharmacy

2 years

(August 2027 * May 2023)

rA/TH/L/14/2O2t Master of Science Program in Regulatory

Science for Pharmaceutical and Health

Products

2 years

(August 1AZJ - May 2023)

TA/TH/LlLs/2A27 Master of Primary Health Care Manage.ment 2 years

(August 2021- May 2023)

TA/rfllL/16/2021 Master of Science Program [n Biomedical

Sciences

2 years

{May 2021 - April 2023)

TAlrHlLllT /2A21 Master of Science in Occupational and

EnvironmentalHealth18 months

(August 202L -January2023)

Master of Science in Public Health Program 2 years

(August 2021 - July 2023)

rA/rH/L/18/2021

r ^/rt1/L/

ls /2027 Master of Science Program in tpidemiology 2 yeals

(June 2021 - June 2023)rA/rH/L/701207t Master of Science Program in lnnovative and

Tropical Health

2 years

(june 2021- May 2023)

Master of Arts Program in Asia Pacific Studies 18 months

(August 202i. -January20231

Master of Arts Program in Diplomacy and

lnternational Studies

2 years

(August 2021- luly 2023)

rA/rHlu2L/2021

r^lrHlL/22/?021

rAlrHlLl23/2021 Master of Arts Prograrn in lnternational 2 years

(August 2021 - July 2023)rA/rH/L/24/2021 Master of Arts Program in Social Science 2 years

(June 2021- May 2023

r^/rH/L/fi/2A21 Master of Public Health (Global Health] 2 years

2021 - M 2023

You are kindly requested to submit your nominations for the relevant programmes along with the

following documents (in four sets) in line v;ith the required qualifications mentioned in lhe "Guidelines"

submitted by TICA on or before 26 of March 2021.

'1. Dully filled Application Form in typed-block letters form along with certified copies o{ the

certificates of Academic and Professional Quatifications (in four sets).

2. Transcrlpt rvith all details of subjects and marks and other required documents specified in the

course details.

3. The completed Medical Report (four reports).

4, Recommendation letter (three referees).

5. Candidates who English is nol the first language and Bachelor's degree was not taught in English

have to pass an English Language proflciency test according lo criteria announced by University

regulations.

Page | 2

Page 3: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

L Duly filled ERD form'Essential ln{ormation the nominee" (Original only)

The guidelines, Course details, Form, Medical Form and the ERD Form can be

downloaded from www.erd.qg:{.lh or

Application-form.html.

The Government clearance to leave the country

after the offer is granted to the nominee.

Your early response in this tegard is highly

Yours faithfully

,,, , :.

tlt

Udeni Udugahapaltuwa

Additional Director General

for Director General

.neUmain/en/relation175500-TIPP-

participate in this programme has to be obtained only

Page 4: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

Duration Application QualilicationsAcademic InstitutionCoursesNo.

l8 months

(August 2021 -January 2023)

1, Bachelor's degree in

related fields.

2. GPA of 3.25

3. TOEFL 400 or IELTS 5,0

or TU-GETS 350

Thammasat

UniversityMaster of Arts Program in Asia Pacific Studies21

l. Bachelor's degree in

related fields.

2. TOEIC 640 or IELTS 5.5

2 years

(August 2021 - July 2023)

Rangsit University22 Master of Arts Program in Diplomacy and

Intemational Studies

2 years

(August 2021 - July 2023)

1. Bachelor's degree in

Social Science, Political

Science, Intemational

relations, Sociology,

Anthropology, History,

Humanity or related

fields.

2. GPA of 2.50

3. TOEFL 437 (PBT) or123 (CBT) or 4l (iBT) orIELTS 5.0

Mae Fah Luang

University23. Master of Arts Program in

Development

lnternational

1. Bachelor's degree or

equivalent.

2. TOEFL 523 (PBT) or 193

(CBT) or 69 (IBT) or

IELTS 5.5,

Chiang Mai

University

2 years

(June 2021 -May 2023Master of Arts Program in Social Science24.

Page 5: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

No Courses Academic lnstitution Duration Application Qualifications

16. Master of Science Program in BiomedicalSciences

Walailak University 2 years

(May 2021- April 2023)l. Bachelor's degree in Science

or equivalent.

2. GPA of 3.503. TOEFL sso (PBT)

17. Master of Science in Occupational and

Environmental Health

Thammasat University l8 months(August 2021 - Jantary 2023)

l. Bachelor's degree in Scienceor equivalent.

2. GPA of 2.75

18. Master of Science in Public Health Program ChulalongKornUniversity

2 years

(August 2021 - July 2023)l. Bachelor 's degree in related

fields.

2. CU-TEP 45

TOEFL 450 or IELTS 4.5

19 Master of Science Program in Epidemiology Prince of Songkla

University2 years

(June 2021 - June 2023)l. Bachelor 's degree in related

fields.

2. work experience related tohealth

3. CU.TEP 60

TOEFL 500 or IELTS 5.0,PSU-TEP 60

20 Master of Science Program in Innovativeand Tropical Health

Mahasarakham

University2 years

(Iune202l - May 2023)l. Bachelor's degree in Health

Science, Public Health,Nursing, Pharmacy or otherrelated fields.

2. GPA of 3.25

3. TOEFL 500 or IELTS 5.0

Page 6: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

No. Courses Academic Institution Duration Appl ication Qual ifications

t1 Master of Science Program in Public Health Naresuan University 2 years

(Itne 2021- May 2023)

1. Bachelor's degree or

equivalent in Public Health,

Health Technology,

Nursing, Medicine,

Dentistry, Pharmacy

Medical Technology or

other related fields or

2. 3 year working experience in

related fields.

t2. Master of Nursing Science Burapha University 2 years

(July 2021 - June 2023)

L Bachelor's degree inNursing or other related

fields

13. Program in

Clinical Pharmacy

Mahidol University 2 years

(August 2021 -May 2023)

1. Bachelor's degree in

Pharmacy

2. GPA of 3.50

t4 Master of Science Program in Regulatory

Science for Pharmaceutical and Health

Products

Mahidol University 2 years

(August 2021 -May 2023)

1. Bachelor's degree inPharmacy or related health

science.

2. GPA of 2.50

3. TOEFL 400 (PBT) or IELTS3.0

15 Master of Primary Health Care Management Mahidol University 2 yearc

(August 2021 -May 2023)

l. Bachelor's degree inMedicine or related health

science.

2. GPA of 2.50

3. TOEFL 500 (PBT) or IELTS5.0

Page 7: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

No. Courses Academic Institution Duration Application Qualifi cations

7 Master of Science Program in AgriculturalScience '

Naresuan University 2 years

(June 2021 - May 2023)l. Bachelor's degree in

Agriculture or other relatedfields.

8 Master of Science Program in AgriScienceand Technology (Postharvest)

King Mongkut's

University ofTechnology Thonburi

2 years

(August 2021- l:u/ry 2023)l. Bachelor's degree in

Engineering or Science

(Agriculture relevant

Biological or EnvironmentalScience, food Technology)or other related fields.

2. GPA of 2.75 or I year

working experience inrelated fields.

9 Master of Science Program in Dermatologyand Dermatosurgery

Institute ofDermatology

2 years

(Irne202l - May 2023)l. Bachelor's degree in

Medicine.2. TOEFL 523 (PBT) or

173 (CBT) or 60 (IBT) orIELTS 5.5

10 Master of Public Health (Global Health) Thammasat University 2 years(August 2021 -May 2023)

L Bachelor's degree orequivalent.

2. GPA of 2.75

3. TOEFL 550 (PBT) or213 (CBT) or 79 (IBT) orIELTS 6.0

Page 8: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

No Courses Academic Institution Duration Application Quahfications

5 Master of Science Program in Food Science

and Technology

Chiang Mai University 2 years

(August 2021 -May 2023)l. Bachelor's degree in Food

Science and Technology,Food Processing Technology,

Packaging Technology,

Marine Product Technology,

Product DevelopmentTechnology, Biotechnology,Nutrition Sciences or other

related fields.2. GPA of 2.50

3. TOEFL Miriimum 523

(PBT) orMinimum 523 (ITP) orMinimum 193 (CBT) orMinimum 69 (IBT) orIELTS 5.5 orCMU-eTEGS 65

6 Master of Science Program in Food

lnnovation, Safety, and QualitYManagement

Khon Kaen University 2 years

(June 2021- May 2023)

AI1. Bachelor's degree in Science

and Food Technology,

Agro-Industrial, Food

Engineering, Food Product

Development or other

related fields.

2. GPA of 3.25 up

3. 2 years working experience

in related fields.

A21. Bachelor's degree in Science

or other related fields.

2. GPA of 2.50 up

3. 2 years working experience

in related fields.

Page 9: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

2021 TIPP Courses

No. Courses Academic Institution Duration Application Qualifi cations

1 Master of Sciencc Program in Bioscience forSustainable Agriculture

Silpakorn University 2 yearc

(July 2021- October 2023)l. Bachelor's degree or

equivalent in Agriculture,

Science or a related field.

2. GPA of 2.50 or higher in the

4 levels score system or

equivalent.

3. Age not more than 40 years

Master of Science in Pharmacy Program inPharmaceutics

Mahidol Universitv 2 years

(August 2021-May 2023)l. Bachelor's degree or

equivalent in Pharmacy or

a related field.

2. GPA of 2.50

3. TOEFL (IBT) 54 up or

TOEFL (ITP) 480 up or

IELTS 5.0 up

J Master of Science/Master of Engineering

Program in Environmental Technology and

Management

King Mongkut's

University ofTechnology Thonburi

2 years

(August 2021 -May 2023)1. Bachelor's Degree in

Engineering, Science,

Economics, AgricultureTechnology, or relatedfields.

2. GPA of 2.50

4 Master of Science Program in Smart GridTechnology

Naresuan University 2 years

(Iune 2021- Muy 2023)1. Bachelor's degree in

Engineering, Science,

applied science or relatedfields.

2.

Page 10: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

ESSENTIAL INFORMATION OF THE NOMINEE

1.1 Title of Programme

1.2 ERD Code

2.1 Ministry

2.2 Agency

2.3 Official Address

2.4 Telephone Number

2.6 Email

1.3 Duration in Weeks

2.5 Fax

ERD FORM

Part 2

3.1 Name ofNominee (As in the

3.2 Sex 3.3 Present Designation

3.5 National Identity Card Number

3.1 Mobile Number

3.9 Date of Birth (DD/MM/YY)

3.1 1 Years of Service to the Govemment in the Nominee's career

3.12 Years of Service in the present Agency

3.13 Name of the contact person in an emergency

3.6 Passport Number

3.10 Age (Years)

3.13.2 Mobile Number

Page 1

3.13.1 RelationshiP

of

I

:

3

I

3.4 Home Address

3.8 Email

Page 11: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

ESSENTIAL INFORMATION OF THE NOMINEE ERD FORM

Name of the Institution Countrv Qualification Year

Duration Countries oftrainings

Less than one week

Greater than one week & Less than 12

weeks(three months)

Greater than 12 weeks & Less than 32 weeks( 8

months)

Greater than32 weeks

l, the undersigned, certify that the details provided in this form describe myself, myqualifications and my experience, truly and correctly.

Date Nominee's Signature

Relevancy of this

Training Programme to

Nominee's Work (Please

Check only one Box)

Vital forpresent

work

DirectlyRelated to

Present

Work

Connected

to Present

Work

Helpfulin Future

Work

For

PromotionsOther

(Specify)

I certify the accuracy of the information given above.

Signature of Head of the Department

and the Stamp

Date

Page 2 of 2

, _ a_ .. .:::: . : ,, ,::: : I .:,r :l

:

I

,

f :i :., "g

:::':,1

:::.::.::...= ,i

Page 12: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

,-il'ti I{}i#, TrcA$ffif ;"il::::t;11:'::''rqi,J"r*

Thailand International Cooperation Agency (TICA)Ministry of Foreign Affairs

APPLICATION FORM

for Thailand International Postgraduate Programme: TIPP

FOR OFFICIAL USE ONLY

Reference No. ...

Received:

Checked:

(Please attach

photograph here)

INSTRUCTIONSThis application form is composed of five parts. Part A to part E shouldbe

compleied in triplicate. part A to part D should be completed by the candidate and

part E by the government authority. All application forms must bc filled in

tvpewritten form. Each question must be answered clearly and completely.

Detailed answers are required in order to make the most appropriate

arrangements. The National Focal Point for International Development

Cooperation of the nominating Government will forward one original and two

copies of certified application form and other related documents to the Thailand

lniernational Cooperation Agency (TICA), the Government Complex, Building B

(South zone),8,h Floor, chaengwatta Road, Laksi District, Bangkok 10210, THAILAND,

through the Royal Thai Embassy/Permanent Mission of Thailand to the United Nations/

Royai Thai Consulate - General accredited to eligible countries/territories.

The candidate is required to attach medical report or health status certification,

No consideration will be given to the late submissions or incomplete

a ns/documents

Course Name:

Institute:

A. PERSONAL HISTORY

Gender

(as shown in passport and kindly attach the copy of your passport,

Given name

information will be used

for travel

Family name Middle nameTitle

o Male

o Femaleo

o

o

o

Mr.Mrs.

Ms.

ReligionAge MaritalStatus

Datc of birthNationalityCity and country of birth

Home address (Please complete this section as

information will bc used for travcl

clear asWork address (Please complete this section as c

information will be used for travel

rlear as

Tclephone No

E-mailFax No

International Airport/City for departure

Fax No: (Country Code / Area

Code/ Number)

of thisRelationshiNoTe

Name and address of Person to be notified in case of emergencY

PageloJ4pages

Attachment 28

Telephone No :

to

Page 13: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

Languages: READ WRITE SPEAKExcel1

entGood Fair

Excell

entGood Fair

Excell

entGood Fair

Mother tongue:

English

Othcrs

English Proficiency Test (please attach)

(only a candidate for a degree course)

! TOBFL Score

E Other (specify) ...

tr IELTs Score

Education Record:Education Institution City i Country Years Attended Degrees, Diplomas

and Certificates

Special fields ofstudyFrom To

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

...tr No

...8 Yes, please specify.

Please give a list ofrelevant publications/researches (do not attach details)

B. EMPLOYMENT RECORD (It is important to give complete information. For each post you have occupied,give details of your duties and responsibilities.)

Attachment 28

Present or most recent post

Dates from toDescription of your work,

including your personal responsibilitiesTitle of your post:

Name of organisation:

Ministrv

Type of organisation

Previous post

Dates from to

Title of your post:

Name of organisation:

Type of organisation:

Official address:

Page2of4pages

Official address:

Description of your work,including your personal responsibilities

Ministry

Page 14: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

C. REFERENCES (Please attach the

and professional experiences.)

D. EXPECTATIONS

Attachment 28

letters from three (3) persons acquainted with your academicrecommendation

training/study on your return home in relation to the

existing in your country in the field of your training.Please describe the practical use you will make ofresponsibilities you expect to assume and the

(Give the attached paper, if necessary)

Ifaccepted for a scholarship award, I undertake to:

a) carry out such instructions and abide by such conditions as stipulated by both the nominating government and

the host govemment in respect of this programme of scholarship;

b) follow thi programme of scholarship, and abide by the rules of the University and Thailand International

Cooperation Agency in which I undertake the scholarship;

c) refrain from engaging in political activities, or any form of employment for profit or gain;

d) study full time, rnake academic progress and submit progless reports to Thailand Intemational Cooperation

Agency;

e) not bring any member of my family to stay with me during the course;

f) retum to myhome country promptly upon the completion of my programme of scholarship.

I also fully understand that if I am granted a scholarship award and violate Thailand Intemational Cooperation

Agency,s rulei and regulations, I may bi required to return part or all of the scholarship paid, depending on the

questions are true, complete and correct.I certify that my statements in answer to the

severity of the violation, without any appeal.

Signature of candidate:

Printed name: .

Date: ..

Page3of4pages

Page 15: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

Attachment 28

E. GOVERNMENT AUTHORISATION (To be completed by the National Focal Point for InternationalDevelopment Cooperation in charge of nomination of the candidate (see guideline for TIPP for detailed information onnomination.))

I certify that, to the best of my knowledge,

(a) all information supplied by the candidate is complete and correct;(b) the candidate has adequate knowledge and experience in related fields and has adequate English

proficiency for the purpose ofthe scholarship in Thailand.

On return from the scholarship, the candidate will be employed in the following position:

Title of post

Duties and responsibilities..

Si gn ature of r es p o n s ibl e s up erttis or

(Ofjicialstamp)

Title: ....

Organisation: ...

Official address:

E-mail

Date: .

National Focal Point for International Development Cooperation Endorsement:

(To be completed by the National Focal Point for International Development Cooperation, please affix seal here orattach a Diplomatic Note)

(OJJicial stamp)

Page4of4pages

Supervisor's Endorsement:

Page 16: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

Check each item in appropriate column

Items Normal

General O

Skin, Scalp O

Lymph nodes O

Eyes O

Ears O

Orthoscopic Exam

Nose O

Pharynx & tonsils O

Teeth O

Thyroid gland O

Lungs O

Heart O

Abdomen O

Liver O

Spleen O

Hernia O

External genitalia O

Rectal exam O

Vertebrae O

Locomotor O

Reflejes O

Mentalhealth status O

Abnormal

ooooo

oooooooooooooooo

Attachment 28

Attachment

Additional Comments

REPORT

Name of Candidate

Country.

Physrcal Examination (To be filled in by physician)

Height

Vision Right

Cms. Weight

. Left

mm.Hg. Pulse............/min.

With glasses / Without glassesE

.kgr. Blood Pressure

Gender:Age: .........

Page 17: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

Attachment 2E

Page I of2 pages

LABORATORY EXAMINATIONS

Blood group .

WBC ..

Differential PMN

Baso

Blood film for malaria

Cells/cu.mm.

Yo Lymp .....% Mono...

%, Band

Colour Sp. Gr

Hb gmYo

o//o

o//o

pH

Sugar

Alb....

Micro: WBC

Casts .

Stool examination for parasite & Ova

ChestX-Rayreport

Urine pregnancy test

Blood Ketones Blie.

......./HPF., Epethelial........./HPF., RBC ...

../ HPD., Others

/HPF

person examined at present in good health and able to work full time?Is the

ly and mentally to carry on intcnsive study away from home?Is the candidate able physical

(such as psychosis and drug addiction) which could present risks for anyone during the scholarship period?

Is the candidate free fiom infectious diseases (such as tuberculosis, leprosy , syphilis and filariasis) and other conditions

candidate) Is the person examined pregnant?(For female

Does the candidatc havc any condition or defect might require treatment during the scholarship period?which

I certify that the candidate is medically fit to underlake the scholarship in Thailand.

Physician signature (with stamp) .. .......M.D.

(.. .. ......... ..)

Full name and address of Examining physician (printed)

Place and Date..

Page 18: Oodo a0od @o)Utlo0dtu0...3. CU.TEP 60 TOEFL 500 or IELTS 5.0, PSU-TEP 60 20 Master of Science Program in Innovative and Tropical Health Mahasarakham University 2 years (Iune202l -

Telephone:

(printed)

E-mail: ....

Attachment 28

Page 2 of2 pages