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Asia Pacific Scholarship Consortium

P.O. Box 196, Chiang Mai University Post Office, A. Muang, Chiang Mai,

50202, Thailand apsconsortium@gmail.com

Masters Scholarships for Individuals from Myanmar, Cambodia and Lao PDR

All information in this form will be kept strictly confidential and will be read only by members of the APSC selection committee and the applicant's prospective university. You MUST answer all questions clearly in English. Application Deadline: December 1, 2009 *The free Adobe Reader (version 7.0 or higher) is required to complete this application. If you do not have the free Adobe reader, you can download it here: http://www.adobe.com/products/acrobat/readstep2_allversions.html

Applicant Name: Date:

Course Preferences

Please check the ONE general subject area that most interests you.

Please list up to three courses from the Course List on pages 3-6 in the APSC Scholarship Overview that best reflect your interests. Next to "1", please fill in the name of the course you would most like to study. Next to "2", fill in the name of your second preference. Next to "3", fill in your third preference. You should only make three choices from the Course List, so please contact us at apsconsortium@gmail.com if you would like additional information on any of these courses.

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It is helpful for us to know as much about your academic interests as possible. Please use the space below to tell us more about your study goals. This information may include possible thesis and research topics, or specific subject-based issues that interest you. This will help us match successful applicants with university programs and faculty offering relevant opportunities.

Community Health

Humanities & Social Science

Policy & Administration Social Work

Media

Environment

Development

Education

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Biographical Information

NICKNAMES:

YearMonthDay

DATE OF BIRTH:

MARRIED SINGLE

PRIMARY E-MAIL:

OTHER E-MAIL:

CURRENT ADDRESS:

PLACE OF BIRTH:

PHONE NUMBER:

*IF YES, HOW MANY CHILDREN DO YOU HAVE?

Please note: It is particularly important that we can contact you between January 8th-18th for scheduling of interviews and exams. If you are out of contact during that time, you may lose the opportunity to be selected for the program.

ETHNICITY:

RELIGION:

Other (please specify)

APSC E-mailFriend or Relative

Faculty MemberInternet Search

How did you hear about this program?

MALE FEMALE

DO YOU HAVE ANY CHILDREN?

APPLICANT NAME:

Educational Background

List your educational history, starting with your most recent qualifications. Attach additional pages if necessary.

Award ReceivedGradesTo

Dates Attended

FromCountry LocationName of School

1:

2:

3:

4:

TRAININGS

Please list the most relevant trainings you attended. Please DO NOT send copies of your training certificates with this application.

Certificate ReceivedDurationYear Training OrganizationName of Training

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2:

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4:

5:

6:

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8:

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Work Background

List your work history, starting with your most recent job. Include volunteer positions and community work, and attach additional pages if necessary.

EMPLOYER:

1:JOB TITLE:

COUNTRY:

To:From:

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you were with this organization:

REASON(S) FOR LEAVING (be specific):

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3:

EMPLOYER:

JOB TITLE:

COUNTRY:

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you were with this organization:

REASON(S) FOR LEAVING (be specific):

EMPLOYER:

JOB TITLE:

COUNTRY:

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you were with this organization:

REASON(S) FOR LEAVING (be specific):

To:From:

To:From:

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LANGUAGE PROFICIENCYUSE THE SPACE PROVIDED TO INDICATE YOUR PROFICIENCY IN LANGUAGE(S):

Proficiency Key: 1=Basic Knowledge; 2=Proficient; 3=Fluent; 4=Native Language

Language Writing ComprehensionReadingSpeaking

INTERNATIONAL TRAVELPlease indicate ALL extensive (more than one month) travel, study, or work that you have had outside your home country.

Dates Reason for Travel (Holiday, Study, Work)Length of StayCountry Visited

Other Information

If you have completed a TOEFL or IELTS exam in the last 2 years, write the date of exam and full results. Also, please attach a copy of your score sheet to this application.

ScoreDate of ExamType of Exam

ENGLISH LANGUAGE TESTING

Essay Questions

In your opinion, why does your country need more people to pursue advanced degrees in your field of interest? Why are you the right person to do this? Please limit your total response to the space provided below.

REASONING

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Essay Questions

BIOGRAPHY

Describe your background including your family, childhood, and educational experience. Describe your work experience and how you became interested in your area of focus. Please limit your total response to the space provided below.

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Describe your career goals and how receiving this scholarship would help you achieve those goals. Provide specific examples of what you would like to achieve in the future. Please limit your total response to the space provided below.

Essay Questions

FUTURE GOALS

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Document Checklist

PLEASE COMPLETE THIS APPLICATION ON YOUR COMPUTER AND EMAIL IT TO APSCONSORTIUM@GMAIL.COM. YOUR APPLICATION WILL BE PROCESSED MORE QUICKLY IF IT IS FILLED IN ELECTRONICALLY, BUT HAND-WRITTEN OR SCANNED COPIES OF THIS DOCUMENT ARE ACCEPTABLE IF YOU ARE UNABLE TO COMPLETE THIS DOCUMENT ON A COMPUTER. ADDITIONALLY, YOU SHOULD INCLUDE SCANNED COPIES OF THE FOLLOWING DOCUMENTS:

A copy of undergraduate degree certificate (or explanation as to why this is not available).

A copy of the page of your passport that includes your picture (if available).

A copy of results from any official English language testing you have taken, such as TOEFL or IELTS.

One ACADEMIC recommendation using the APSC Reference Form.

apsconsortium@gmail.com

PLEASE E-MAIL THIS COMPLETED APPLICATION TO:

HAVE YOU COMPLETED THIS FORM?P.O. Box 196, Chiang Mai University Post Office, A. Muang, Chiang Mai,

50202, Thailand apsconsortium@gmail.com

Date:Type Full Name Here

Please read below and sign if you consent to the following:

I certify that the above information is correct. I understand that all of the credentials submitted in support of my application to Asia Pacific Scholarship Consortium will become property of APSC and are not returnable to me. I authorize APSC to share my application, recommendations, and transcripts with the APSC Scholarship Committee, and relevant universities.I further understand that, if accepted into the program, I will provide any additional information required to facilitate the scholarship process.

One PROFESSIONAL recommendation using the APSC Reference Form.

A copy of undergraduate final transcript (or explanation as to why this is not available).