MPH-Application Form

Current Mailing Address:

Home (reachable address): *

City: *

Country: *

Tel.: *

Fax:

Email: *

Work:

City:

Country:

Tel.:

Fax:

Email:

College/University level education (beginning with most recent):

Name and address of instituttion *

Location (Country) *

From (mo/yr) *

To (mo/yr) *

Degree obtained *

Major *

Special training course attended:

Title of Course

Location (Country)

From (mo/yr)

To (mo/yr)

Work Experience (beginning with most recent):

Position *

Organization/Agency *

From (mo/yr) *

To (mo/yr) *

English Proficiency Test: *

TOEFL -iBT

Score

Date of Test

TOEFL -ITP (Mahidol arrangement)

Score

Date of Test

IELTS

Score

Date of Test

MU GRAD TEST

Score

Date of Test

Wait for English score test (specify)

Specify

Date of Test

I have attended English-language degree course.

Native English Speaker

Remark: The test date must be within the previous 2 years.

Expected funding for the study: *

I will be self-funded.

I intend to seek for partial scholarship#.

I will be self-funded with an intention to seek for partial scholarship.

I might be funded by a sponsoring agency:

#Remark: The Admission committee for the MPH Program will exempt the research fee based on your academic and career profiles. It is mandatory for all candidates to submit the complete set of required documents.

References:

Reference 1:
Reference 2:

Name: *

Position / Title: *

Organization: *

Tel/Fax: *

Email: *

Name:

Position / Title:

Organization:

Tel/Fax:

Email:

Accompanying Documents Required: (Each files must be less than 5 MB)

Deposit slip for application Fee (50 US$) *

Certified true copy with official stamp and registrar’s signature of transcript *

Medical examination report *

One-page statement describing in your own words your long-range education, professional goal and concept paper of research (A4) *

English Proficiency report *

If application has a founding agency, a letter to certify that he/she gets scholarship is needed

If an applicant is self-sponsored, bank statement with the fixed amount of 8,000 USD is needed

A letter certifying work experience *

Fill in Application