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) )
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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 -
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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
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
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
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
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:
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: .........
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)