(ASEAN University Network / Southeast Asia Engineering Education Development Network)

Application Form of Master 's Degree Program JFY2017

Instruction:
1. Please read Implementation Guidelines and Application Form for Master's Degree Program JFY2017
2. Please note that applications without an endorsement letter will not be accepted.
3. Applicants must prepare Host Institution application form and follow instruction in the Implementation Guidelines for Master's Degree Program JFY2017
4. Application form can be downloaded from http://www.seed-net.org
5. Please fill in all information (if applicable) in the space provided.
6. DO NOT insert rows and/or columns into this file.
7. DO NOT convert this file to PDF format or any other formats.
The AUN/SEED-Net Application Form in Microsoft Excel format with a scanned copy of the Endorsement Letter must be emailed to master@aun-seed.net with subject line "Application: Master JFY 2017".

The hard copy of the AUN/SEED-Net Application Form and Host Institutions Application Form with the Supporting Documents must be sent to the contact person at Sending Institution.
The Sending Institution will send the complete applications with the Endorsement Letter to AUN/SEED-Net and Host Institutions directly.
Section 1: Personal Information
First Name
Last Name
Gender
Nationality
Date of Birth (MM/DD/YYYY)
Age
Marital Status
Current Position/Status
University/Organization
Department/Division
Mailing Address

Photo
(Taken within
the past 6 months)

Email
Mobile
Tel/Fax
Please kindly provide valid contact information. Some Host Institution (HI) may contact the applicant directly for interview or request additional information.
Endorsed by Sending Institution (SI)
* Please note that applications without an Endorsement Letter will not be accepted.
Section 2: Academic Qualification
Educational Record (Higher Education)
Please list all degrees received.
Period
No.

Institution/University

From (Month/Year)

To

Degree

Major

(Month/Year)

Cumulative Grade Point Average

(CGPA)
(Honors, if any)

Status

1
2
3
Class Ranking
No.

Institution/University

department/
program

Degree

Placed at rank

Total Number
(Students)

CGPA

Signed by
(Name)

1
2
To verify your class ranking, please submit certified Letter on Academic Standing (Attachment 3)
Thesis Topic
Please submit Thesis Abstract for the previous
degree received (if any).
English Qualification (if any, please submit the certificate)
English Proficiency Test
Score
Taken Date (MM/DD/YYYY)

Others (Please specify)

Section 3: Employment Record

Job Record (After graduation)
Period
No.

Organization

From (Month/Year)

To

City/Country

(Month/Year)

1
2
3
Section 4: Achievements
Other Awards (an additional page can be attached in Microsoft Word File)

Page no. 1 of 3

Position/Title

Brief Job Decription

(ASEAN University Network / Southeast Asia Engineering Education Development Network)

Application Form of Master 's Degree Program JFY2017
Section 5: Program Selection
(Please select from Attachment 1)
Selection of Doctoral Degree Sandwich Program
Selection

University

Department/Faculty

Field of Study

Preferred Advisor

Division

(if any)

Intake
Semester

Year

Priority (1)

Priority (2)

Remark: If you submit more than one application for the same Host Institution for the same field, the two applications for Priority 1 and Priority 2 will be considered as one application.

Section 6: Research Proposal

Research Title
(Please submit Thesis Proposal/Research Study Plan in any format)
Thesis Proposal/Research Study Plan is one of the most important factors to be considered for AUN/SEED-Net Scholarship.

Publications (journal, proceedings, etc).

List recent publications (not older than 2 years) in journals or conference proceedings in which you have published your research work. Required information for publication is 'Name of the authors/co-authors', Title of the paper, Name of the journal
or conference, Volumn number and year of the publication, and Page Number'. Please also state if the publication is your Master's thesis research. For an additional page if necessary, must be submitted as a separate file.

(Please submit the copy of your publication.)

Section 7: Statement of Purpose

Additional page can be attached to the application form (Microsoft Word)

Section 8: Medical Record
Before you complete the Medical Record Questionnaire, you are hereby notified that a medical condition resulting from an undisclosed pre-existing condition may not be financially compensated and may result in
termination of your scholarship.
1.Present Medical Status
(a) Do you currently use any medicine or have regular medical checkup by a physician for your illness?
If yes, please attach your doctor's letter (written in English) that describes current status of your illness and agreement to join the program.
(b) Are you pregnant? If yes, please specify months of pregnancy
2.Past Medical History
(a) Have you had any significant or serious illness?
(b) Have you ever been a patient in a mental clinic or been treated by a psychiatrist?
Section 9: Declaration
I declare that all information in this application as well as the attached documents are true and correct to the best of my knowledge. I acknowledge that the provision of incorrect information or supporting documents may
result in termination of scholarship, and that I will have to be responsible for an expenses incurred from my misinformation.
If awarded the scholarship, I agree:
(a) to abide by the rules and regulations of the Host Institution, Japanese Supporting University, AUN/SEED-Net Project, and JICA;
(b) to follow course regulations and instructions and abide by such conditions as may be stipulated by both the host institution, Japanese Supporting University, and AUN/SEED-Net in respect of this course of
study;
(c) to refrain from engaging in political activities, or any form of employment for profit;
(d) to submit any progress reports or evaluation questionaire which may be prescribed;
(e) to return to my home country at the end of my scholarship period.
I also fully understand that, the scholarship, if awarded, may be subsequently withdrawn for failure of making adequate progress, or for other sufficient cause including health condition as determined by AUN/SEED-Net.
Do you apply for any other scholarships?
I am planing to apply for teaching position or researcher at the Member Institution after my Master's Degree study under the AUN/SEED-Net Project.

Signature:

Date:
Page no. 2 of 3

(ASEAN University Network / Southeast Asia Engineering Education Development Network)

Application Form of Master 's Degree Program JFY2017

Information of Applicant
Please do not change anything in this part.
You may change this part by revising the information filled in page no. 1 and 2.

Name
Sending Institution (SI)
Contact Information
Program Selection
(1st Priority)
(2nd Priority)
Class Ranking
CGPA
English Score

0
Email:

Mobile:

Tel/Fax:

, , / ()
0
-

Score:

Document Checklist
Please ensure to submit the following documents.
Compulsory
1. AUN/SEEED-Net application form with photo & signature
2. Official Bachelors Degree certificate (certified copy)
3. Official Bachelors transcript with grade points (original or certified copy)
4. Official Master's Degree certificate (certified copy)
5. Official Master's transcript with grade points (original or certified copy)
6. Certified letter on academic standing as Attachment 3 of Implementation Guideline for Master's Degree Program JFY 2017.
7. An Endorsement Letter from Rector or Dean of Sending Institution.
(with current status or position in case applicant is a faculty member)
8. A letter of recommendation from your advisor
(Form in Attachment 4 of Implementation Guidelines for Master's Degree Program JFY 2017)
9. Two letters of recommendation from faculty members who are able to evaluate student's
(Form in Attachment 4 of Implementation Guidelines for Master's Degree Program JFY 2017)
10. Certificate of English Proficiency
11. Thesis Abstract
12. Thesis Proposal/Research Study Plan
13. Additional Document (please specify):

Page no. 3 of 3
(Summary Page)

Answers

SN ID
0

1
0

0
0

3
4

5. Date of Birth
(MM/DD/YYYY)

4. Nationality

3. Gender

2. Last Name

1. First Name

Questions

SN ID
4
5

Section

Topic
Personal Information

Items

30-Dec-1899

6
0

7
0

0
0

9
10

11. Mailing Address

10. Department/Division

9. University/Organization

8. Present Position

7. Marital Status

6. Age

6
10
11

Section 1: Information about the Applicant

Current Status
Contact Information

11

12
0

13
0

14

15

0
0

15
16

[1] Institution/University

14

[1] Degree

13

Endorsed by SI

14. Tel/Fax

13. Mobile

12. Email

12
16
17

Contact Information
Degree

17

18
30-Dec-1899

19
30-Dec-1899

20

21

0
0

21
22

[2] Degree

20

[1] Status

[1] CGPA

19

[1] Period: To
(Month/Year)

[1] Period: From

(Month/Year)

[1] Major

18
22
23

Degree (1)

23

24
0
30-Dec-1899

25
26

27

30-Dec-1899

27
0

28

[2] Status

26

[2] CGPA

[2] Period: To
(Month/Year)

25

[2] Period: From

(Month/Year)

[2] Major

[2] Institution/University

24
28
29

List All Degrees (Max. 3)

Degree (2)

29

30
0

31
0

32

33

30-Dec-1899

33
30-Dec-1899

34

[3] CGPA

32

[3] Period: To
(Month/Year)

31

[3] Period: From

(Month/Year)

[3] Major

[3] Institution/University

[3] Degree

30
34
35

Section 2: Academic Qualification

Degree (3)

35

36
0

37
0

38

39

0
0

39
40

[1] Total Number

(Students)

38

[1] Placed at rank

37

[1] department/
program

[1] Degree

[1] Institution/University

[3] Status

36
40
41

on 2: Academic Qualification

Clas

Class Rank (1) Bachelor's

41

42
0

43
0

44

45

0
0

45
46

[2] Placed at rank

44

[2] department/
program

43

[2] Degree

[2] Institution/University

[1] Signed by
(Name)

[1] CGPA

42
46
47

Class Rank (Max. 2)

Class Rank (2) Master's

47

50

48

49

52

Thesis

English
Qualification

English Qualification

Thesis

English
Qualification

English Qualification

Thesis Topic

[2] Signed by
(Name)

[2] CGPA

[2] Total Number

(Students)

ank (2) Master's

51

50

51

53

Other Test; specify

49

English Proficiency Test

(TOEFL/IELTS)

48

52

53

54
30-Dec-1899

55
0

56

57

English Qualification

30-Dec-1899

57
30-Dec-1899

58

[1] City/Country

56

[1] Period: To
(Month/Year)

55

[1] Period: From

(Month/Year)

[1] Organization

Taken Date
(MM/DD/YYYY)

Score

54
58
59

English Qualification

Job (1)

59

60

61

62

63

64

65

Section 3: Employment Record

Job Record (After graduation)

Employment Record (Max. 3)

60

61

30-Dec-1899

62

63

[2] City/Country

[2] Period: To
(Month/Year)

[2] Period: From

(Month/Year)

[2] Organization

[1] Position/Title

[1] Brief Job Decription

Job (2)

30-Dec-1899

64

65

66
0

67
0

68

69

30-Dec-1899

69
30-Dec-1899

70

[3] City/Country

68

[3] Period: To
(Month/Year)

67

[3] Period: From

(Month/Year)

[3] Organization

[2] Brief Job Decription

[2] Position/Title

66
70
71

ent Record
raduation)

d (Max. 3)
Job (3)

71

72
0

73
0

74

75

0
0

75
76

(1) Field of Study

74

(1) Department/Faculty

73

(1) University

Awards (If Any)

[3] Brief Job Decription

[3] Position/Title

72
76
77

Section 4:
Achievements

Achievements/
Awards

77

78
0

79
0

80

81

0
0

81
82

(2) Department/Faculty

80

(2) University

79

(1) Intake Year

(1) Intake Semester

(1) Preferred Advisor

(if any)

(1) Division

78
82
83

83

84
0

85
0

86

87

0
0

87
88

6.1 Research Title

86

(2) Intake Year

85

(2) Intake Semester

(2) Preferred Advisor

(if any)

(2) Division

(2) Field of Study

84
88
89

Section 6: Proposed Research

Study Plan

6.1 Research
Title

89

90

91

94

95
Section 8: Medical Record

92

93

Present (b) IF Yes

Present (a)
0

91

Present (a) IF Yes

1.Present Medical Status

Statement of Purpose

6.2 Publications (journal,

proceedings, etc). Within
2 years

Statement of
Purpose

Present (B)

6.2 Publications
(journal,
proceedings,
etc). Within 2
years

90

93

Section 7:
Statement of
Purpose

tion 6: Proposed Research

Study Plan

92

94

95

96

97

98

99

100

ection 8: Medical Record

Section 9: Declaration

96

97

99

Section (9) Date

Past (b) IF Yes

0

98

Section (9) Signature

Section 9: Signed

Past (B)

Past (a)

Past (a) IF Yes

2.Past Medical History

101

30-Dec-1899

100

101

1
0

2
0

0
0

4
5

6. Certified letter on
academic standing
(Attachment 3)

5. Official Master's
transcript with grade
points (original or certified
copy)

4. Official Master's Degree

certificate (certified copy)

3. Official Bachelors
transcript with grade
points (original or certified
copy)

2. Official Bachelors
Degree certificate
(certified copy)

1. AUN/SEEED-Net
application form with
photo & signature

1
5
6
Cover Page

Document Checklist
Compulsory

7
0

8
0

10

0
0

10
11

12. Thesis
Proposal/Research Study
Plan

11. Thesis Abstract

10. Certificate of English

Proficiency

9. Two letters of
recommendation from
faculty members who are
able to evaluate student's
(Attachment 4)

8. A letter of
recommendation from
your advisor (Attachment
4)

7. An Endorsement Letter
from Rector or Dean of
Sending Institution.

7
11
12

Cover Page

Document Checklist

Compulsory

12

13. Additional Document

(please specify):

13

13