Post on 27-Jan-2023
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IN THAIL,A,ND FOUNDATION:,
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THE AMERICAN CHAMBER OF COMMERCE IN THAILAND
fio n1:61A reJ:nH [$ 5elmfl[ru
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AMCHAM rr,rii.qro7th floor, GPF Witthayu Tower A, 93/1 Wireless Road, Lumpini, pathumwan, Bangkok 10330
fel: 0-2254-1041 Exl. 224 Fax: O -2251-1605. Email: Foundation@amchamthailand.com
THE AMERICAN CHAMBER OF COMMERCE IN THAILAND
uon1:a'laI t fl 1l [14rl: s rrl d [r4 s
7th floor, GPF Witthayu Tower A, 93/1 Wireless Road, Lumpini, Pathumwan, Bangkok 10330
oau6l uo?j an r.,r?r o:uYr1.r
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t. lual-a:r a:-u4ux an1:n"r o r in-ulu ::trqtru2. 1:.rtir,rorrl 1 nlilntto'ru 01lr-'lliaYin a r-rria 1rrirfi 8 Personal Essay)
3. iirturu-o: :s,iret-r:J:vrrtu tlas .i1tultl-o:fndnurrio u ar I l6u:-l:a.trir turl o': fan"n:
4. rir rurHnnr:riuur a iyrnnlflnlr6nuror n anrudnBlilanu-1r Io uh ttao'] tr nnr': lSuuo;el"a.r'[o"nr:i'u:ar
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8. Lonfl.]fiY1l:o.r:lu'tsir o,!n:auflt-.ll riur6aula.lzu- nn:o.l Io ulfinnao-leio'bJdrflu{:"1:a.r
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:r alsi rrinmu an{r.: ronru/uirc-yrlr{rrriru }it#urio6la :-u:a.r:r er'ldo1nfid?elvl$ Io uro"rla'lfitnr:raia
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21,
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-AMCHAM re,rL.A\o
7th floor, GPF Witthayu Tower A, 93i1 Wreless Road, Lumpini, pathumwan, Bangkok 'lO33O
f el: 0-22U-1O41 Ext. 224 Fax: O -225'l-1605. Email: Foundation@amchamthaitand.com
tuarl-o:sa:-u11r,to'rnfi anr:rirora.r3nir'luilrcrmo'lmsI6ogdriru
( tlJrnu 6
rFl0u )
This information will be used for the sole purposes of determining eligibility for the AMCHAMFoundation scholarship, and for remaining in contact with scholarship awardees in future.lnformation will be reviewed only by the AMCHAM scholarship review committee and will not be
shared with any other third parties.
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- .), "-nrrnortanar,.Jy) rnmsruro.rllnurlronlrhromQrinlrvnralnuluuournnrsran.rnnr'rlrrJplu{Lrnnu;n?r n1r'lo.iNnr6u Jiyonlrn,tollrrnurr:r n tyrsLrl'rulryqinutnrfiu1fiunyq;lrifinmut5{or.rn1firirr.lnnnduuontuioqrnnruvnrer.:nrrtri"jr
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do - u.,u*nu (1-[1fl / u1']ff1'l) .
Name - Surname (Mr. / Ms.)...
6areiu lNickname)
iur6auflrfio (Date of birth) ... a1u (Age) #rut16 (Nationality) ..
AMCHAM Scholarship Application Form
) ,)tnln lt',to1 x m (Moo)
Ltll'l i (Sub-district)
o-,tuio (Province)
:fi-ff'l iufiti (Postcode) . In:o*nri ltetepnonel .
flodrloolrl{finooo Io(Current Address)
(n: 1 Please/1 l-rufiorur:or Parents' Home E r avl-n Dormitory
dul otner E 1L.J:o:tl:r ua; t6uo please specify) ......... '
raa.jfi firaool
THE AMERICAN CHAMBER OF COMMERCE IN THAILAND
uanr:6ro rru3n"*lu :srma'lm u
"r0 u (Soi) .....
t1Jo (District).
nuu (Road)
ratfi 1tto1 ..............
tLlJ1n (Sub-distric0..
o-.:l':-o lProvi nce) ..
{au (Soi)
..... L1lsl (District)..
:ra-a'[:J:utfi ri leostcooel
........... Email Address .......
rurofirio.r Retatives E
nuu (Road)
g
In:a=rrifi afr a (Mobile Phone)..
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A. d:sr?!ir sie (Personal Data)
irfi oeior fl srfr E ufrwuln:il:sfl1n$ (Addr
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AMCHAM rrr.,irL.arir
THE AMERICAN CHAMBER OF COMMERCE IN THAILAND
u on1:a10$ltn$ ['r{tlIslylcl [mu
7th floor, GPF Witthayu Tower A, 93/'1 Wireless Road, Lumpini, pathumwan, Bangkok 10330
Tel: 0-2254-1041 Exl.224 Fax 0 -2251-1605. Email: Foundation@amchamthailand.com
e. fia anr:6ngr (Current and Previous Education
l-IA l)l',t',tYlUlng .........
Name of University....
nI 3..........
1t1t4R......
:r-arindnur (Student lD)J -)n''lR,tflnu1tu n (Year of study commencing August this year) .
,iruruflnr:dnur (Length of course) : 3 years
4 years
5 years
6 years
nloi'roidtr5onl:6n:trlufl (Expected course completion date)
Faculty.......
Major ........
T&OUn1:61nl'1
Educational Level
fioanru-u / o-ornio
School Name / Province
n r*E / d'rzli9r1
Faculty / Malor
ilYral''rrro
Graduation Date
,J
(GPAX)
uffl slu
([/iddle school)
1lr: n rfixuugt5'tatalt (Y]n )
(Vocational Degree - if any)
l,r'rir u1 a-u 1ur n to u til u
Yt'6u) (University - if any)
dru:u/il
Amount / yearOrganization i lnstitution / Other sponsor (Please give details)
oorin: i anru."r+ / rlonn afiuarlunr:t#r1ure s'td:"rmunr:6nr*r
From / To
$61
4l
rlonui*iirirn-o:-u4unrt6nrr6u 1 v6o1d tr ld r Eltri, n:ru, :sr:runctdso
Are you currently receiving any scholarships? E uo t E Yes, please provide details
trtrtrtr
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(High school)
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THE AMERICAN CHAMBER OF COMMERCE lN THAILAND
fi an1ta10[ :n$ [urjTslmd[ms
--
lua6oroulo':-uqunr:6nr*r 6r.1 1 u5o'hi tr lri I trfui, n:rur:cu:raasr5us
Have you "r",
,"l"ir"d "ny
scholarships? E ruo I E Yes, please provide detaits
From / To
ooo"n: / etolu-u / ltona fiarir aur.rnr:t#nu
Organization / lnstitution / Other sponsor (Please give details)
(Activities / Community Service)i.5O O\tOnT
Name of Organization
fl / rea'r
When
A9ao5u1uumu1fltlac v]$1m
Describe Your Role
fl a n 1:o'1 rilr{01 t,[
Highlight the results of your activities
c. rioXadruntaunix (Family lnformation)
E aqidr un-r.l luire together)
ld'frnr:afllarlurirunitliunlnlns (How are you suppofted?)
E 0or 1r"tn"4E ior-r.rr:or (Parents)
o o ?) oI :U 2J1 a"lE firlnnro,s (Guardian)
r a:[mtoGlGl0
Phone No.
rds
Deceased
tr
o'] u
Age
u03Jg100u
Living
tr
to io'r Father's Name
(or) Guardian's Nameoirl nn:ao
AMCHAM rner,rro7th floor, GPF Witthayu Tower A, 93/'l Wireless Road, Lumpini, Pathumwan, Bangkok '10330
fel 0-2254-1041 Ext.224 Fax: O -2251-1605. Email: Foundation@amchamthailand.com
fi an::eruanva-ndo: uacfi an:: 41d1fi tfl uilrefum{aiaarsr:rusfi fotor+uactriuHa
drueu I flAmount / year
dorunl1rdu:acJo.tiol!rTol (Parents' Marital Status)
E ntjrirt (Divorced) E uann-uo ti lseparateal
E an:or lMotherl
E e.ifio ne:cnru (Other- Provide details)
5l
*** * I,a
-AMCHAM rn,"rL,rro
THE AMERICAN CHAMBER OF COMMERCE IN THAILAND
fi anlrd'lor Bn"$lu :cma'tylE
7rh floor, GPF Witthayu Tower A, 93/1 Wireless Road, Lumpini, Pathumwan, Bangkok 10330
fel 0-2254-1041 Ext.224 Fax:0 -2251-'1605. Email: Foundation@amchamthailand.com
Father or Guardian's Occupation olgy{floituolfi:a nota0
Mother or Guardian's Occupation olfiYulo.: 1:o.1fi64 p?rl n n:al
u1uo1'l
Employer
j ^- d,au:l+t4 / oJ6n5
Company Name /
Organization
o'tl.fiu0
Position
:Ts'idlr6ou
lncome/Month
:T u'ld6r+ 1
Other income
I yeat
fiN1U[]10
Comments
UtBYl lAO.tFlfl:IOflr1{
Company
tou'taflio50't311fifl0
Government /State Enterprise Ea16nAd:&
Self Employed trtnltu0t
Retired tr'irooru
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6ourror Mother's Name u0tlrloo tl
Living
tr
o1g
Age
rfls
Deceased
tr
r a:tYltooa o
Phone No.
v rJl u rl1Gl
Comments
'lUt1
Other income
I yeal
r1u [o / ]sol,[
lncome / Month
Gtl t[fil{t
Position
o lt*?t / oof|n5
Company Name /
Organization
1{1U01it
Employer
rtBtlvlo oJ o n:Ia n5r[
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Government / State Enterprise tra16Y{ AA:}
Self Employed trIn PU fll
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Unemployed or Housewife tr
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AMCHAM ::r.,,r .'. r,
7th floor, GPF Wifthayu Tower A, 93/1 Wireless Road, Lumpini, pathumwan, Bangkok .l O33O
fel 0-2254-1041 ExL224 Fax:0 -2251-1605. Email: Foundation@amchamthailand.com
)vfruo.rix rior l:or [5E.ra1 d1o-u rxlridN-Flrrt amu (sibtings)
e A-dnlnril$ frr,rh ar rig M Ifr 6i1rl.[']flanfinfrnur lPhotos of Applicant's House)
Alta
Name
o''l u
Age
o15v{
Occupation
6tn11,t6nt*1 / da1ufi ?i1,J1r.[
School / University / Work place
ttfllooat6rail
Monthly income
, A- a 6t r'Anlrd'tor Bfi%", ossil $run'rro:xod oUlio afrl.inAnEl lritJ'l 14-lnttr.J?1[N ttll.tol.Jfi o n1l6'r
a [rJ;fi'fi ", ocu{,JlfrsJurim u1 a-ufl r'luuasfindnurornno-n-amitunrtn''s rfi o n
lf falsified information is provided, AMCHAM will notify the university and the applicant will be
disqualified for future scholarship selections'
l4olj',tutglu R',tUUon$
92*9,q:iln1u:J1Uilool"JU n1Uilfl.jil0.0n?1J t91 99
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THE AMERICAN CHAMBER OF COMMERCE IN THAILAND
ff an1:ft'totrJinu[1l :etmf1[mu
=
(Photo of family home. Show full outside view of house)
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,-
-7'\ floor, GPF Witthayu Tower A, 93/'l Wreless Road, Lumpini, pathumwan, Bangkok 10330
AMCHAM ;nrri,i.'o fel 0-2254-1041 ExI. 224 Fax O -2251-1605. Emait: Foundation@amchamthailand.com
o. rirt#lirs[ac:raloiiloou-u lexpenses & tncome)
:Ioa l-ur"r llr,i'rlo":-:t riurirtr'tir I My current stipend / a owance
LJ:o:r:1eirl#eir arluusiac16 a (Ptease Provide Detaits of Monthty Expenses)
U']m o1n (From)
a:ouair / r?rjna:or
Family or Guardian
:uo'lit
Employment
nuG|.
Student Loan
M5aH&A n1l:G|nrAor+ 6J (:3rl)
Other (specify)
r6iouas
(Monthly Allowance)
61mfln / n1 ''r /
eirb,l
(Rent & Utilities /
Month)
n1$1NU / O',t
Io uar:
(Transport /
Month)
ft''lo''tff1l
(Food /
monlh)
o'rtn'5dflr1 /
a}{toart m
Phone &
inlernet / month
(Other
Personal
Expenses /
Month)
a'ttalllgtl /eirrir:s /
o''l 6ll3t 11,[ 8
oa lma
(Tuition &
other fees /
semester)
fl'11.11{\t alo ua 3
orJ n:ni
sia rn an
(Books &
supplies /
semester)
fltJflt10:1j111{OAIt?lllUt:U,tfl't1 1 11U',l n:ror+ rf,$n1B'ro-onnr*desoutoo srr r u-rl'a o-.1eia'[r] d
ln your own words, provide a 1-page personal essay on:
a) Why you wish to apply for this scholarship?
Y|1[ n.,fl ntl al!?llJ /
b) What academic "nO'p"r"on"t
achievements make you a suitable candidate to receive this scholarship?
n rr l air rSa eir uisr nr: tta t rir uer-rlo rir 'r dri rlr.r"rin ri u u6 e'ir a n r:o:'[o"i! m u?
c) How do you think you will benefit in terms of career and personal development from obtaining this
Scholarship?
rn::Iurfo'runr:y{-rir'roura{rrdiimardno-rulorirrdrin6uu6o'jro:to-ilarn4unr:6no',of.:dz
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THE AMERICAN CHAMBER OF COMMERCE IN THAILANDfi a nl r6i1 a $Jin- lr.lrj:e rm a'ln s
E. rfia$risooarilsoiu4rr (Personal Essay)
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t-
-AMCHAM rr.qrL,to7th floor, GPF Witthayu Tower A, 93/'l Wireless Road, Lumpini, Pathumwan, Bangkok 10330
fel 0-2254-1041 Ext.224 Fax: O -2251-1605. Email: Foundation@amchamthailand.com
riryr rirz arir rie ra nd1:rl:sn ounlran-n:z o:-ur1uu onr:frro rru3ri'r+r ar d Required documents
E h al-n:r a:-rvrur onr:a"r a triflulu :trrstrrE hriurorril r urirn:roru ot u u-ll-a vt'.r a u-rl-a 1rrirfi 8 Personat Essay)
E rir rurr.r-ar:r.l:g,iro-r ::trru ttas air turlt-sr:u-n 6n:*rtria l nr utfu:-tt:o': cir turlalrial-n:
E dr rur zu n nr:riuur a,Jyrnnlfl nrrdnuror nanru6n:*rrJool-u Io uluuso.rnn nr:riuuogoia.tlrinr::=u:o'r, & j l, 4
a1n fl'tlvlu1duLvl'l u (n1n0.[fl n:tn ufln:r1lufln1uu0o flnulau6) t:J:off.!fl1Lu1 anl:l:uunln-&-dn1xulrl{frlu)
E iir rur vr: r:r'r urir ud fi6 a u-n6n:sr for rosr.n:or
E drrurl-sr:i:rrirar-r:l:strtu rio tt-o:l"r:rtnt:1la.Jfio1 'rlo1 tliolnr u t6u:ll:a'leirtur*rAlJ oonlr t:"u:a.lar n aror:rj g auiu 1or n arar:rJffrJTnEl a'tol:rifi1,l{1rt1o-T1 xso a1a1:dr.ldau)
Iil:olfuru r4 a{ruo1 xJ tLuu
I qe -'l,Jq w:'..-- -U ra nar::=l:a,::r u'loil ato:aln:1/ t.lulo0u1J0Ji nflia{ tou Lxl'Jonaonoa [!uL]Ju,l:!:an
n'ri.trnr: rrin.lruigiatn-o 1fil#rri,:fra:-u:a.::r s'ldornudr uorr+ Io uu-rrfirllril u'rrutfluti:Yr:o'l
:r u'[oi urinrru nn{r,:rontW:ti:iyrn{rldru trit#urioila iu:oo:ru'ldor nurir slru lostdlla't
fio nr:uiorir-onr:il:al:ru'lei or6n5a:: trllfirrir ilo:-u:ao:r er'ldnrruurruvriorun-uu-o:rir:rsnr:J[,
loueiarfi ill$qjlI1un5an-r:rtnr::tou1i1u1t-xn1u 1u [lJ d'llt'lll:r:an-A L t'U rau.rao:l:al ttao.l nr:l al:l tiau'Lrttavria:l-ln-u', YlulaanllfilaL rnu[u:J:tLYlfl LYlu
**fi 'ln l o n f, '11lrrlu'lri o:ui:1* uan'ud1at 3fi'r1 4,3 ^ Ji ,r,^ 6r
?1{d?l 5110r t}l?l01:fll'l tUd 3J O:9 0: U vl l.{
THE AMERICAN CHAMBER OF COMMERCE IN THAILAND
ra o nr:rYr o rruini+lr+rj:s rm o'[n a
application
Date
.. ?1{?1
Applicant's Signature
0it0 ff n:/...........(....
el
F. ff #nmfirJ:cn o u nlrr-uvrufl 'lrdnul (check List)
dru rdrl o:=r.r:o.r.irl'oorr rufilqin rir: r,rn",rr u odrfluorr ruo5':unr n nsiol nrL!:nirn :snr: rl1nd1r',{to'1
lfi-orafi rilurfi ot-rra'rolr:Lqfi Yri'lunr::-tlruraonr:o"rotl?n-uE
I hereby certify that the above statements are true and correct to the best of my knowledge'
lunderstandthatanyfalsifiedinformationwillresultinthedisqualificationofmyScholarship
)
t***r*****
I,-I
AMCHAM rnarrero
THE AMERICAN CHAMBER OF COMMERCE IN THAILAND
fi an1id1or 3rirlu :erma'lms
7th floor, GPF Wifthayu Tower A, 93/1 Wireless Road, Lumpini, Pathumwan, Bangkok 10330
fel 0-2254-1041 Exl.224 Fax:0 -2251-1605. Email: Foundation@amchamthailand.com
a eA,afiu,raolu5o\Jflx1EJ tcfl qolrrarnon:: o1no1o'lrgt1il:nr*'l (1)
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I'tlt ta'')
t <A ,ao'ro1:u / 0101ttiYt -nu1ll0{ u'lu / u'l'l fl'l')
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riruom er:J::ltq 6
qirufi o n:: utn snr:rlr ufi g:J::I utriei o a-'ro I
s0)
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AMCHAM rr rrrr:r:.r
THE AMERICAN CHAMBER OF COMMERCE IN THAILAND
fian1501ar rn% [urJtsrfl6 lflEJ
7th floor, GPF Witthayu Tower A, 93/.1 Wireless Road, Lumpini, pathumwan, Bangkok 10330
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