Asia Pacific Scholarship Consortium

Masters Scholarships for Individuals

from Myanmar, Cambodia and Lao PDR
All information in this form will be kept strictly confidential and will be read only by members of P.O. Box 196, Chiang Mai
the APSC selection committee and the applicant's prospective university. You MUST answer University Post Office,
all questions clearly in English. Application Deadline: December 1, 2009 A. Muang, Chiang Mai,
50202, Thailand
*The free Adobe Reader (version 7.0 or higher) is required to complete this application. If you do apsconsortium@gmail.com
not have the free Adobe reader, you can download it here: http://www.adobe.com/products/
acrobat/readstep2_allversions.html

Applicant Name: Date:

Course Preferences

Please check the ONE general subject area that most interests you.

Community Health Development

Education Environment
Humanities & Social Science Media
Policy & Administration Social Work
Please list up to three courses from the Course List on pages 3-6 in the APSC Scholarship Overview that best reflect your
interests. Next to "1", please fill in the name of the course you would most like to study. Next to "2", fill in the name of your
second preference. Next to "3", fill in your third preference.

You should only make three choices from the Course List, so please contact us at apsconsortium@gmail.com if you would
like additional information on any of these courses.

1:

2:

3:
It is helpful for us to know as much about your academic interests as possible. Please use the space below to tell us more
about your study goals. This information may include possible thesis and research topics, or specific subject-based issues
that interest you. This will help us match successful applicants with university programs and faculty offering relevant
opportunities.

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 Biographical Information

APPLICANT NAME:
NICKNAMES: MALE FEMALE

MARRIED SINGLE
CURRENT ADDRESS:

PLACE OF BIRTH:
DATE OF BIRTH:
RELIGION:
Day Month Year
ETHNICITY:
PRIMARY E-MAIL: How did you hear about this program?
OTHER E-MAIL: Internet Search Faculty Member
PHONE NUMBER: Friend or Relative APSC E-mail
Other (please specify)
DO YOU HAVE ANY CHILDREN?

*IF YES, HOW MANY CHILDREN DO YOU HAVE?

Please note: It is particularly important that we can contact you between January 8th-18th for scheduling of interviews and
exams. If you are out of contact during that time, you may lose the opportunity to be selected for the program.

Educational Background

List your educational history, starting with your most recent qualifications. Attach additional pages if necessary.

Dates Attended
Name of School Country Location From To Grades Award Received
1:

2:

3:

4:

TRAININGS
Please list the most relevant trainings you attended. Please DO NOT send copies of your training certificates with this application.

Name of Training Training Organization Year Duration Certificate Received

1:

2:

3:

4:

5:
6:

7:

8:

9:

10:

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 Work Background
List your work history, starting with your most recent job. Include volunteer positions and community work, and attach
additional pages if necessary.

EMPLOYER: COUNTRY:
1:
JOB TITLE:

From: To:

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you were with this organization:

REASON(S) FOR LEAVING (be specific):

EMPLOYER: COUNTRY:
2:
JOB TITLE:

From: To:

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you were with this organization:

REASON(S) FOR LEAVING (be specific):

EMPLOYER: COUNTRY:
3:
JOB TITLE:

From: To:

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you were with this organization:

REASON(S) FOR LEAVING (be specific):

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 Other Information

LANGUAGE PROFICIENCY
USE THE SPACE PROVIDED TO INDICATE YOUR PROFICIENCY IN LANGUAGE(S):
Proficiency Key: 1=Basic Knowledge; 2=Proficient; 3=Fluent; 4=Native Language
Language Speaking Reading Writing Comprehension
English (Required)

ENGLISH LANGUAGE TESTING

If you have completed a TOEFL or IELTS exam in the last 2 years, write the date of exam and full results. Also, please attach a
copy of your score sheet to this application.
Type of Exam Date of Exam Score

INTERNATIONAL TRAVEL
Please indicate ALL extensive (more than one month) travel, study, or work that you have had outside your home country.
Country Visited Length of Stay Dates Reason for Travel (Holiday, Study, Work)

Essay Questions

REASONING
In your opinion, why does your country need more people to pursue advanced degrees in your field of interest? Why are you
the right person to do this? Please limit your total response to the space provided below.

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 Essay Questions

BIOGRAPHY
Describe your background including your family, childhood, and educational experience. Describe your work experience
and how you became interested in your area of focus. Please limit your total response to the space provided below.

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 Essay Questions

FUTURE GOALS
Describe your career goals and how receiving this scholarship would help you achieve those goals. Provide specific
examples of what you would like to achieve in the future. Please limit your total response to the space provided below.

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 Document Checklist
PLEASE COMPLETE THIS APPLICATION ON YOUR COMPUTER AND EMAIL IT TO APSCONSORTIUM@GMAIL.COM. YOUR
APPLICATION WILL BE PROCESSED MORE QUICKLY IF IT IS FILLED IN ELECTRONICALLY, BUT HAND-WRITTEN OR SCANNED
COPIES OF THIS DOCUMENT ARE ACCEPTABLE IF YOU ARE UNABLE TO COMPLETE THIS DOCUMENT ON A COMPUTER.
ADDITIONALLY, YOU SHOULD INCLUDE SCANNED COPIES OF THE FOLLOWING DOCUMENTS:

A copy of undergraduate degree certificate (or explanation as to why this is not available).

A copy of undergraduate final transcript (or explanation as to why this is not available).

A copy of the page of your passport that includes your picture (if available).

A copy of results from any official English language testing you have taken, such as TOEFL or IELTS.

One ACADEMIC recommendation using the APSC Reference Form.

One PROFESSIONAL recommendation using the APSC Reference Form.

Please read below and sign if you consent to the following:

I certify that the above information is correct. I understand that all of the credentials submitted in
support of my application to Asia Pacific Scholarship Consortium will become property of APSC and
are not returnable to me. I authorize APSC to share my application, recommendations, and transcripts
with the APSC Scholarship Committee, and relevant universities.I further understand that, if accepted
into the program, I will provide any additional information required to facilitate the scholarship process.

Type Full Name Here Date:

PLEASE E-MAIL THIS COMPLETED APPLICATION TO:

apsconsortium@gmail.com

P.O. Box 196, Chiang Mai HAVE YOU COMPLETED THIS FORM?
University Post Office,
A. Muang, Chiang Mai,
50202, Thailand
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apsconsortium@gmail.com

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