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

Application Form of Master's Degree Program JFY 2016

INSTRUCTION
After being endorsed by Sending Institution(s), applicants are required to submit two types of applications;
1. AUN/SEED-Net Application Form
2. Host Institutions Application Form.
Applicants MUST submit:
Step 1: Hard Copy
The Sets of Documents in separate envelops to the contact persons at Sending Institution which endorses you. Note. Each
envelop MUST clearly indicate its set of documents for AUN/SEED-Net, 1st and 2nd Priority of Host Institution/Field. Please follow
the instruction in the Implementation Guidelines for Master's Degree Program, 10. Application Procedure and Submission
Timeline.
The Sending Institution will send the complete applications with the endorsement to AUN/SEED-Net, and Host Institution.
Step 2: Soft Copy
AUN/SEED-Nets Application Form in Microsoft Excel format, and a scanned copy of the Endorsement Letter, to the
AUN/SEED-Net via E-mail: master@aun-seed.net with subject line "Application: Master's JFY 2016". Please DO NOT
convert the file into any other file type than Microsoft Excel.

* Please note that applications without an endorsement letter will not be accepted.

Document Checklist
Please answer Yes/No in the space provided for items submitted.
Compulsory
Yes

1. This application form, completed with photo & signature

2. Official Bachelors Degree certificate (certified copy)
3. Official Bachelors transcript with grade points (original or certified copy)
4. Certified letter on academic standing of the Bachelors study which indicated the Class Rank and Cumulative GPA,
from the Dean or Registrar Office of your graduated institution
(Form in Attachment 3)
5. Letter of Endorsement from the Rector or Dean of Member Institution to which you belong
(with current status or position in case you are a faculty staff.)
6. A letter of recommendation from your advisor (Form in Attachment 4)
7. At least one Letter of Recommendation from the Dean or Head of the Department to
which you belong or from which you graduated. (Form in Attachment 4)

Additional (Recommended to submit)

8. Certificate for English Proficiency (please select below)
Others (Please specify)

9. Thesis Abstract
10. Thesis Proposal/Research Study Plan
10.
11. Additional Document (please specify):

Cover Page

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

Application Form of Master's Degree Program JFY 2016
Instruction:
1. Application form can be downloaded from http://www.seed-net.org
2. Please fill in all information (if applicable) in the space provided.
3. DO NOT insert rows and/or columns into this file.
4. 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's
JFY 2016".
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 to which the
applicants belong for endorsement from the Dean or designated person.
The Sending Institution will send the completed applications with the endorsement to the AUN/SEED-Net and Host Institutions directly.
Section 1: Information about the Applicant
Personal Information
Family Name
Given Name
Gender
Nationality
Date of Birth (MM/DD/YYYY)
Age
Marital Status
Current Status
Present Position
University/Organization
Department/Division
Contact Information
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 for the screening by HI.
Endorsed by Sending Institution (SI)
To verify your status of endorsement, please submit the Letter of Endorsement.
* 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)

Degree

To

Major

(Month/Year)

Cumulative Grade Point

Average (CGPA)
(Honors, if any)

Status

Class Rank
No.

Institution/University

department/
program

Degree

Placed at rank

Total Number
(Students)

CGPA

Signed by
(Name)

To verify your Class Rank, 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)

Section 4: Achievements
Other Awards (For an additional page if necessary, must be submitted as a separate file.)

Page no. 1 of 2

Position/Title

Brief Job Decription

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

Application Form of Master's Degree Program JFY 2016
Section 5: Proposed Graduate Program
(Please select from Attachment 1)
Selection of Master's Degree 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: Proposed Research Study Plan
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

For an additional page if necessary, must be submitted as a separate file.

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 course of study.
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.

Signature:

Date:

Section 10: Declaration for Graduating student or young graduate only

I wish to become a teaching staff or researcher at the Member Institution after my Master's Degree study under the AUN/SEED-Net Project.
Signature:

Date:
Page no. 2 of 2

Answers
1. Family Name

2. Given Name

3. Gender

4. Nationality

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

Questions

SN ID
1
2
3
4
5

Section
S

Topic

Items
Personal Information

0
0
0
0
30-Dec-1899

6. Age

7. Marital Status

8. Present Position

9.
University/Organization

10. Department/Division

11. Mailing Address

6
7
8
9
10
11

Section 1: Information about the Applicant

Current Status
Contact Information

0
0
0
0
0
0

12. Email

13. Mobile

14. Tel/Fax

Endorsed by SI

[1] Degree

[1] Institution/University

12
13
14
15
16
17

Contact Information
Degree

0
0
0
0
0
0

[1] Major

[1] Period: From

(Month/Year)

[1] Period: To
(Month/Year)

[1] CGPA

[1] Status

[2] Degree

18
19
20
21
22
23

Degree (1)

0
30-Dec-1899
30-Dec-1899
0
0
0

[2] Institution/University

[2] Major

[2] Period: From

(Month/Year)

[2] Period: To
(Month/Year)

[2] CGPA

[2] Status

24
25
26
27
28
29

List All Degrees (Max. 3)

Degree (2)

0
0
30-Dec-1899
30-Dec-1899
0
0

[3] Degree

[3] Institution/University

[3] Major

[3] Period: From

(Month/Year)

[3] Period: To
(Month/Year)

[3] CGPA

30
31
32
33
34
35

Section 2: Academic Qualification

Degree (3)

0
0
0
30-Dec-1899
30-Dec-1899
0

[3] Status

[1] Institution/University

[1] Degree

[1] department/
program

[1] Placed at rank

[1] Total Number

(Students)

36
37
38
39
40
41

on 2: Academic Qualification

Clas

Class Rank (1) Bachelor's

0
0
0
0
0
0

[1] CGPA

[1] Signed by
(Name)

[2] Institution/University

[2] Degree

[2] department/
program

[2] Placed at rank

42
43
44
45
46
47

Class Rank (Max. 2)

Class Rank (2) Master's

0
0
0
0
0
0

48

49

50

51

52

English
Qualification
English
Qualification

Thesis

[2] Signed by
(Name)

Thesis Topic

English Proficiency Test

(TOEFL/IELTS)

Other Test; specify

English Qualification

[2] CGPA

Thesis

English Qualification

[2] Total Number

(Students)

ank (2) Master's

53

Score

Taken Date
(MM/DD/YYYY)

[1] Organization

[1] Period: From

(Month/Year)

[1] Period: To
(Month/Year)

[1] City/Country

54
55
56
57
58

English Qualification
59

English Qualification

Job (1)

0
30-Dec-1899
0
30-Dec-1899
30-Dec-1899
0

60

61

62

63

64

65

Section 3: Employment Record

Job Record (After graduation)
Employment Record (Max. 3)

[1] Position/Title

[1] Brief Job Decription

[2] Organization

[2] Period: From

(Month/Year)

[2] Period: To
(Month/Year)

[2] City/Country

Job (2)

30-Dec-1899

30-Dec-1899

[2] Position/Title

[2] Brief Job Decription

[3] Organization

[3] Period: From

(Month/Year)

[3] Period: To
(Month/Year)

[3] City/Country

66
67
68
69
70
71

ent Record
raduation)

d (Max. 3)
Job (3)

0
0
0
30-Dec-1899
30-Dec-1899
0

[3] Position/Title

[3] Brief Job Decription

Awards (If Any)

(1) University

(1) Department/Faculty

(1) Field of Study

72
73
74
75
76
77

Section 4:
Achievements

Achievements/
Awards

0
0
0
0
0
0

(1) Division

(1) Preferred Advisor

(if any)

(1) Intake Semester

(1) Intake Year

(2) University

(2) Department/Faculty

78
79
80
81
82
83

0
0
0
0
0
0

(2) Field of Study

(2) Division

(2) Preferred Advisor

(if any)

(2) Intake Semester

(2) Intake Year

6.1 Research Title

84
85
86
87
88
89

Section 6: Proposed Research

Study Plan

6.1 Research
Title

0
0
0
0
0
0

90

91
Section 7:
Statement of
Purpose

tion 6: Proposed Research

Study Plan

92

93

94

95
Section 8: Medical Record

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

6.2 Publications (journal,

proceedings, etc). Within
2 years

Statement of Purpose

Present (a)

Present (a) IF Yes

Present (B)

Present (b) IF Yes

1.Present Medical Status

96

97

98

99

100

ection 8: Medical Record

101

Section 9: Declaration

Past (a) IF Yes

Past (B)

Past (b) IF Yes

Section (9) Signature

Section (9) Date

Section 9: Signed

Past (a)

2.Past Medical History

30-Dec-1899

102

103

1.

2.

3.

4.

Section 10: Declaration for

Graduating student or young
graduate only

Section 10: Signed

Section (10) Signature

Section (10) Date

Completed & Signed

Application Form

B Certificate

B Transcript

Class Rank (Attachment

3)

Compulsory

30-Dec-1899

Endorsement Letter

Recommendation Letter
(Advisor) Attachment 4

Recommendation Letter
(Dean or Head of the
Department graduated)
Attachment 4

English Certificate

(e.g. TOEFL, IELTS,

GRE, Others, None)

(Others)

5.
6.
7.
8.

Cover Page

Document Checklist

mpulsory
Additional (Recommended to submit)

0
0
0
0
0
0

Thesis Abstract

Thesis
Proposal/Research
Study Plan

Additional Document

(Please specify:)

9.
10.
11.

Additional (Recommended to submit)

0
0
0
0