amcham - กองกิจการนิสิต

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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: [email protected]


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

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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)

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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: [email protected]

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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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) ......... '

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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)

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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


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: [email protected]

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

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Graduation Date

,J

(GPAX)

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([/iddle school)

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(Vocational Degree - if any)

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Yt'6u) (University - if any)

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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

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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

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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

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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)

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Phone No.

rds

Deceased

tr

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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: [email protected]

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)

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*** * I,a

-AMCHAM rn,"rL,rro


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: [email protected]

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

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Company Name /

Organization

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lncome/Month

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Other income

I yeat

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Comments

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Company

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Age

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Deceased

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Phone No.

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Comments

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Other income

I yeal

r1u [o / ]sol,[

lncome / Month

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Position

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Company Name /

Organization

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Government / State Enterprise tra16Y{ AA:}

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Unemployed or Housewife tr

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*** ******t

t**I,-

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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: [email protected]

)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

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Monthly income

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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$

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(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: [email protected]

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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-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: [email protected]

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

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?1{d?l 5110r t}l?l01:fll'l tUd 3J O:9 0: U vl l.{


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


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: [email protected]

a eA,afiu,raolu5o\Jflx1EJ tcfl qolrrarnon:: o1no1o'lrgt1il:nr*'l (1)

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t*********

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AMCHAM rr rrrr:r:.r


fian1501ar rn% [urJtsrfl6 lflEJ

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

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

- r; ,a11r{0dorutoiro?1aJ tEfl qo lra E no ntrEJo.l n 01o..trdfr:J5nr*1 (2)

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