F. No. l5-3/2020-85.

3
Government of India
Ministry of Education
Department of Higher Education
External Scholarship Division
Dated the I I September 2020
NOTICE

The Chulablrorn Graduate Institute (CGI), Thailand is offering scholarships to Indian students
under the Chulabhorn Graduate Institute Post-Craduate Scholarship Program for Non-ASEAN Applicants
fortlre Academic Year202l. The Scholarships are being offered to pursue a Master's Degree study atthe
CGI.

2. The Eligibility Criteria for applying to this Scholarship are as under:

. Applicant rnust be under the age of 30 years

. Applicant must hold a Bachelor's Degree with a cumulative GPA of at least 2.15
(on a 4.0 GPA Scale) irt one of the following fields:
o Sciences: Chernistry, Biology, Biological Sciences, Molecular Biology,
Env ironmental Sciences
o Medical Science: Medicine,MedicalTechnology
o Phannacy or Plrarmaceutical Sciences
o Applicants from other related fields are also welcome to apply
o Must have experience in Scierrtific laboratory research
o Must have demorrstrated English proficiency, preferably on one of two recognized
test of language proficiency (TOEFI-, IELTS)
Must provide a statement of purpose explaining their interests in the study

3. The Scholarship will cover the following fields of study:

. Applied Biological Sciences: Environrnental Health
o Environmental Toxicology
o Clremical Sciences

4. Scholarship will cover tuition and other academic fees, round trip airfare, accommodation,
morrtlrly stipend, book allowance, lrealth irrsurance and others.

5. The Scholarship award will cover 6 weeks refresher courses followed by a period of 2 years
Master's Degree study, subject to an annual review of the scholar's satisfactory progress. Refresher
courses will tentatively cornrnence in June 2021 while the acadernic program will commence in August
202t.

6. Applicants must apply on the MHRD SAKSHA Portal (www.proposal.sakshat.ac.in/scholarship/)

The application window for this Scholarship is from I I Septemb er 2020 to 15 Octob er 2020.
 7. The Applicants must have the following documents ready at the time of applying online for this
scholarship on MHRD SAKSHAT portal:

' Scanned Copy of the completely filled Chulabhorn Craduate Institute post-Graduate
Scholarship Program Scholarship Application Form (copy Enclosed).
o Scanned Copy of Academic Documents like Class X Markshedt/Pass Certificate. Class
XII Marksheet/pass Certificate, Degree Certificate
o Scanned Copy of TOEFL/IELTS Certificate
o Scanned copy of proof of having experience in Scientific laboratory research
o Scanned copy of self attested statement of purpose explaining their interest in the study
o If percentage system is followed in your University/lnstitution, please provide scanned
copy of your academic transcript.

N.B: Size of individual document should not exceed I MB.

8' 5 Applicants will be nomirrated by the External Scholarship Division, Ministry of Education
to
the CGI for the award of this scholarship. Criteria followed lbr nornination will be
as follows:

"Priority for rromination would be given to candidates who have completed their last qualifying
exam
either frorn Institutes of National Importance (INl)/Central [Jniversities (CU)/Centrally
funded Technical
Institutes (cFTI)A"lational Assessment and Accreditation Council (NAAC)
accredited institutions.,,

In case of tie, weiglrtage would be given to the marks obtaine,J in the last qualifying
exam.

9' All Applicants must send the following documents by post to the Under Secretary
(Scholarship), Ministry of Human Resource Development, Department
of Higher Education, West
Block-l,2nd Floor, Wing-6, R. K. Puram, New Delhi- 110066. Documents to be posted i,clude the
following:

r Completely filled Application Form (in original)

o Full Academic Transcript
o Three Recommendation Letters .

. Staternerrt of Purpose explaining interest of study

o Medical History Report (Copy enclosed)
. Other supporting documents to facilitate applicittion screening

The documents should reach the aforementioned address latest by 17 October 2020.

10. Queries rnay be directed to es3.cdLr(4)rric.in by email or at 0 l1-26172492 by telephone.

Encl: As above

l.r/r,$4 d\q',^A;u
(Kailash Chandra)
Section Officer (External Scholarship)
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CHULABHORN
ROYAL ACADEMY
Chtrlabhorn Craduelc lnstitutc

Ghulabhorn Graduate lnstitute

Post-Graduate Scholars hi p Program
Scholarship Application Form
(For NON-ASEAN Applicants)

IMPORTANT INSTRUCTIONS:
o . Each question must be answered clearly and completely.
. Duly completed application forms should be forwarded to the Chulabhorn Graduate
Institute before deadline of application
o Incomplete aonlications will not be considered.

Proposed field of study: I Applied Biological Sciences: Environmental Health

I Errrironmental Toxicology

I Che-ical Sciences

PERSONAL DATA

Title Family name / Surname First name Sex

(as shown in passport)

D Mr. tr Male

n Mrs. f F'emale

n vr.
City and country of binh Nationality Date of Birth Age I fr4aritat Religion
(DDMMATY) I statut

Single

Married

Divorced

Page 1 of5 pages

 COMMU}iICATIOI{ AND }IAILII(G ADDRESS

Applicant's Office Address: Applicant's Home Address:

Office telephone NO: FAX: Home telephone NO: FAX;

Countryi Areal Number Countryl Areal Number Countryl Areal Number Countn4 ArealNumber
Offrce Email: Personal Email:

Name and address of person to be notified in case of emergency:

Telephone No: Rel

Countr"yl Areal Number
Intemational Airport / City of Departure

EDUCATION RECORD
Education Institution Cityi Years Attended Degrees, Diplomas Major field Cumulative
Country From To or Cerlificates of studv GPA

Have you ever been trained in Thailand? If yes, what course@

List of your publications/researches (do not attach details)

n 4 -a
 ta

EMPLOYMENT RECORD

Present or most recent nost: Previous nost:

Employer: Employer:

Years of service (from-to): Years of service (from-to):

Title of your post/position: Title of your posVposition:

Type of your organization: Type of your organization:

Govemment/ Semi Government/ Private/ NGO Governrnent/ Semi GovernmenU Private/ NGO
Main function of the organization: Main function of the organization:

Office address: Office address:

Description of your work including your responsibilities (Please continue on supplementary

pages if necessary)

L
 EXPECTATTONS

Please describe the practical use you will make of this study on your return horne in relation to
the responsibilities you expec:t to assume and the condition existing in your country in the field
of your training. (Please continue on supplementary pages if necessary)

LANGUAGES (No consideration will be given to applicants without language proficiency test

English Proficiency Test* (please attach)

Page4 of5 pages

 It

SUPPORTING DOCUMENTS

[-l ,r*r"ript G)

[-l ,"*.. of Recommendation

name title institution/company

name title institution/company

name title institution/company

l_l u"ai"al Certificate

l_l otr,"tt (Please specify)

Please read the following and sign

form or
I understand that withholding pertinent information requested in this application
ineligible for application
intentionally giving false infirmation will make me automatically
accordance with the
consideration. I hereby certify that my education and qualifications are in
admission requirements and all information given in this form is true'

Applicant's Signature

Date

Duly completed application form should be forwarded to:

The Chulabhorn Graduate Institute

906 Kamphangphet 6 Road, Talat Bang Khen,

Laksi, Bangkok 10210

THAILAND
Email: cgi-academic@cgi.ac.th http://www'cei'ac'th

Page 5 of5 Pages .

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.:

tvtedicd ffistorv anO

Name of Nominee ..................Age..............

*Physical Examination (To be filled in by physician)

Present Status

Height .. .. .... ....... Cms. Weight . .. .... ...kgs. Blood Pressure mm.Hg. Pulse ................/rnin.
Vision Right . ... Left Eyes . . . ... With glasses i Without glasses
a) Do you currently use any drugs for the treatment of a medical condition? (give name and dosage)

( )No
( ) Yes : n€Lme of medication ( ), Quantity (
b) Are you pregnant?

( )No
( )Yes:( months)

c) Are you allergic to any medication or food?

( )No
( )Yes: ( )Medication:( )Food:( )Other:

Laboratory Examinations
Blood group ..Blood film for malaria ..........Hb ......gmyo

WBC .. ..... Cells/cu.mm.

Differential PMN...,......% Ly-p

......%Mono ....% Eos.............%

Baso ...........% Band.. ... % Blast ........%

Urinalysis: Colour ..,... Sp. Gr.... ...... pH Sugar

Alb.. ...... Blood ...Ketones Blie...

Micro : WBC. ..../FIPF.,RBC ................/HPF.,Epethelial....... /I{PF.

Casts. ....../ HPD., Others

Stool examination for parasite & Ova

ChestX-Rayreport

Urine pregnancy test

.l ,.

ar

Check each item in appropriate column

Item Normal Abnormal Additional comment

General t]t]
Skin, Scalp E T
Lymph nodes tf E
Eyes T T
Ears tl D
Otoscopic Exam

Nose I r
Pharyrx & tonsils n tl
Teeth r D
Thyroid gland n E
Lungs tl tl
Heart D E
Abdomen E l
Liver E E
Spleen n E
Hernia E tf
External genitalia I-l tl
Rectal exaln. E n
Vertebrae f tl
Locomotor E tl
Reflexes f n
Mentai health status [-_] n

t
 :l t)

I
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tf

Is the nominee able physically and mentally to carry on intensive study away from home?

Is the nominee free from infectious diseases (such as tuberculosis, leprosy, syphillis and
filariasis) and other conditions (such as psychosis and drug addiction) which could present
risks for anyone during the fellowship period?

Does the nominee have any condition or defect which might require treatment during the
fellowship period?

Full name and address of

Examining physician (printed)

Phvsic.iarr
( \
T)ate