amcham scholarship application form -...

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THE AMERICAN CHAMBER OF COMMERCE IN THAILAND

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A MCHAM '; : .. \t i.i' ··:n

71h floo r, GPF Witthayu Tower A, 93/1 Wireless Road, Lumpini, Pathumwan, Bangkok 10330

Tel : 0-2254-1041 Ext. 224 Fax: 0-2251-1605. Email: [email protected]

AMCHAM Scholarship Application Form

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;l.,m-J\91 (Province) .. ... ....... .... .......... .. ... .. .... . ..

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~11Jiil (Tambol ) ... ... .. .... .... .. .... .. .... ..... ... . Ellbfle:J (Amphur) .. .. ... ... ...... ... .. ..... . .

;l.Jv.1~ (Province) .. ..... .. .. ...... .......... ... .... .. .... 'lVt ... ~1l.J·n!l-rnEJ (Postcode) .. .. ... ...... ..... ..

1'Yl'ifi ... VfrlijEJntl (Mobile Phone) .... .... .. .......... ... .. Email Address .. ..... ..... .... .. .............. .... ......... .... .. ..... .... .... .............. ..

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r1rn::: ..... ..... ....... .... ... .... ....... ......... ........ .. ........ .. .. .... ... .. Faculty .. ........ .. . .... .. .. ...... .. .. .. ..... ... .... .... .... .. .. ..... .... : .... .. .... .. .. ..

1"ll'1 bfln ... .... ... .................. .. ... .... .. .... .. ... .. .... .... .. ..... .. ... Major . . . .. .. . ... .. .. .. . .... . . . .. . . ... .. ... .... . .. .. . ....... ..... .. ..... .. .. .

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o "' "' ~ !'I .d d . A th· ) n1iil-Jflnl!f1"ll''H.u'Yl (Year of stu y commencmg ugust 1s year ..... ........ .. .... .. ................ .. ...... .. ... ... ....... .. ......... ..... ..

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y th fl oor, GPF Witthayu Tower A, 93/1 Wireless Road, Lumpini, Pathumwan, Bangkok 10330

Tel : 0-2254-1 041 Ext. 224 Fax: 0-2251 -1605. Email : Foundation@amchamthailand .com

'ii1 U1UU n11ftnl.~1 (Length of course) 3 years D 4 years D 5 years 0 6 years 0

• 0 ~ ., 1 n mfil11 ';l :: ff1 l1~n1"'lf'fn'I.Y1 u (Expected course completion date) .... ..... .... ......... ........ ... ...... ... .. .... ... ..... ......... ... .... .. .. .

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Faculty I Major Educational Level School Name/ Province Graduation Date

lllil.JlliU

(Middle school)

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(High school)

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(Vocational Degree - if any)

:!JV\1l'\'11..11~£.1 (YI 1 nb~£Jb1tJu dd '\'lull.) (University - if any)

Are you currently receiving any scholarships 0 No I 0 Yes, please provide details

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From I To Organization/Institution/ Other sponsor (Please give details)

Have you ever received any scholarships 0 No I 0 Yes, please provide details

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Amount I year

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Amount I year

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h floor, GPF Witthayu Tower A, 93/1 Wireless Road, Lumpini, Pathumwan, Bangkok 10330

AMCHAM IH.\ILi;'''D Tel: 0-2254-1041 Ext. 224 Fax: 0 -2251-1605. Email: [email protected]

(Activities I Community Service)

Name of Organization When Describe Your Role Highlight the results of your activities

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Alive Deceased Age

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Phone No.

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A MCHAM : :\:..· .. <• 7 th floor, GPF Witthayu Tower A, 93/1 Wireless Road, Lumpini, Pathumwan, Bangkok 10330

Tel: 0-2254-1041 Ext. 224 Fax: 0 -2251-1605. Email : [email protected]

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I year

Comments

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AMCHAM :· : .. \il> ·. 'r:.>

71h floor, GPF Witthayu Tower A, 93/1 Wireless Road, Lumpini, Pathumwan, Bangkok 10330

Tel: 0-2254-1041 Ext. 224 Fax: 0 -2251-1605. Email : Foundation@amchamthailand .com

.d e:n~~ ~ d 0 ~HI £11~ 61'tl1% n~1/61'm~'l'l'l'11\l1~ •

Name Age Occupation School/University/Work place

(Photo of family home. Show full house)

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If falsified information is provided, AMCHAM will notify the university and the

applicant will be disqualified for future scholarship selections .

~·u.r 1~Giat~ •n~

Monthly income

71 .

·THE AMERICAN CHAMBER OF COMMERCE IN THAILAND

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AMCHAM ;;;"'.: '·' f:·

7th fl oor, GPF Witthayu Tower A, 93/1 Wireless Road, Lumpin i, Pathumwan, Bangkok 10330

Tel: 0-2254-1041 Ext 224 Fax: 0-2251-1605. Email: Foundation@amchamthailand .com

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E. t~hllf>L~Ill\IA'l13J'nil'i"tJ'11-fl (Personal Statement)

In your own words , provide a 1-page personal statement on :

a) Why y9u wi sh to apply for this scholarship?

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b) What academic and personal achievements make you a suitable candidate to receive this scholarship?

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Scholarship?

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= THE AMERICAN CHAMBER OF COMMERCE IN THAILAND ~

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AMCHAM !;·;,\ :u, ,::,


Tel: 0-2254-1041 Ext. 224 Fax: 0 -2251-1605. Email: [email protected]

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1 hereby certify that the above statements are true and correct to the best of my knowledge.

I understand that any falsified information will result in the disqualification of my scholarship

application.

Applicant's Signature Date ... " ... v .J

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Tel: 0-2254-1041 Ext. 224 Fax: 0 -2251-1605. Email: Foundation@amchamthai land.com

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

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.::= 'Vle:Jm-s~1e:naJ~n"~-~>tutl-a:::mY~lnEJ ~~.-~.; __ ·.=:-~ __ .~=_ , THE AMERICAN CHAMBER OF COMMERCE IN THAILAND

7 th floor, GPF Witthayu Tower A, 93/1 Wireless Road , Lumpini, Pathumwan, Bangkok 10330

AMCHAM fi !. ··r :Mm Tel: 0-2254-1041 Ext. 224 Fax: 0 -2251-1605. Email: [email protected]

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

11 I '

----·- -------------- . ,., ,.,. ______________ ___ - - - - - -----

--E:.;_;··· :~:~;:,:~~:~~~:~n:~:"R OF COMMERCE IN THAILAND ~L~ 7111 floor, GPF Witthayu Tower A, 93/1 Wireless Road, Lumpini, Pathumwan, Bangkok 10330

AMCHA M '1 L·\ ~t .. ·m Tel: 0-2254-1041 Ext. 224 Fax: 0 -2251-1605. Email: [email protected]

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Tel: 0-2254-1041 Ext. 224 Fax: 0 -2251-1605. Email: [email protected]

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~'"WA~ THE AMERICAN CHAMBER OF COMMERCE IN THAILAND ~

ime-~ Vi B n1"H•l1 B b3J~ flU 1 Ulh:: b't1 ~tltHJ ~

... ~ 71h floor, GPF Witthayu Tower A, 93/1 Wireless Road, Lumpini, Pathumwan, Bangkok 10330

AMCHAM H:/.n <'<D Tel: 0-2254-1041 Ext. 224 Fax: 0-2251-1605. Email: [email protected]

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What is community service? It is doing work for a good cause for in the

community or Community Volunteering

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v' Public ground cleaning work, public park and community

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v' Public school help teaching, cleaning and building maintenance; " '

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v' Assisting voluntary and community clubs, and facilities; f11'j'lhvm~tJ

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../ Working with individuals or groups in need; f11':ivl1~1'U~9l'el1'ff1'lf1m'l1~tJ

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./ supporting local init iatives; fll'Hl''l1'1H1'~'W 'l1'Wfl~:J.Jm'W1~li'tJ'l~'W flfli1t~~1'lt'lS'W

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What is NOT ucommunity Service" n1lm'j:J.JU:i:l'j~ill'1i'll'W'JhmM~enr~Yl:J.J clll

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x Freshman events- 'll'Wl'Vh'lf; 'll'Wi'1J1!eJ'l n1Jm'j:J.JtJUfl~lti~1J'I!t~.:J

x Mandatory Univers ity Activities fll'j~'J:J.Jfl1"lfl'.i'j:J.J'IJtl'l:J.J'I11i'Ylt:Jlrl'a~t!nffmn9i'u'll'li'l

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x Religious Activ it ies f1l'j~1:J.Jfl\Jm'j:J.J'Yll~fl'l~'W1 ani1mh~1i'W mni'Tl.Jty-imnm, 'lf1a1'~

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