CENTER FOR HUMAN RIGHTS STUDIES AND SOCIAL DEVELOPMENT

(CHRSD)
Graduate Studies Building, Mahidol University
Salaya, Puttamonthon, Nakorn Pathom, 73170 THAILAND
Tel: 66-2-4414125 ext. 400, 401 Fax: 66-2-8892151
Email: ohrsd@yahoo.com, admin@humanrights-mu.org
www.humanrights-mu.org

APPLICATION FORM
Doctor of Philosophy in Human Rights and Peace Studies
(International Program)

Please complete all four pages and tick boxes as appropriate. Return the
complete form with all other supporting documents to the Center for Passport-size photograph
Human Rights Studies and Social Development, at the address above.

Deadlines for June 2010 admission:

-First round, 15 November 2009 (results will be available in Dec. 2009)
-Second round, 31 January 2010 (results will be available in Mar. 2010)

PERSONAL DETAILS

LAST NAME/FAMILY NAME: ………………….……. FIRST NAME: …………………..……………

MIDDLE NAME (S): ……………………………..………TITLE ……………………..............................

GENDER: Male Female

MARITAL STATUS: …………………………… DATE OF BIRTH ………..……...…………………

(day / month / year)

NATIONALITY:…………………………………………………………………………………………......

PERMANENT ADDRESS: CORRESPONDENCE ADDRESS:

(if other than address given)

Email: Email:
Tel: Fax: Tel: Fax:
ACADEMIC HISTORY (you may separately attach details)
Please enter, in chronological order, details of all programs attended since completing a bachelors degree.
Please indicate clearly if the program attended resulted in an academic degree.
Please supply a copy of your academic transcripts or certificate. All applicants should complete the
following sections or attach a supplementary sheet giving relevant details.

Dates of Attendance Institution / Country Degree awarded and grades Major or Principal subjects
From To / class of honours

Please give details of research and publications you have undertaken. In the description please state the type
of publication (for example, dissertations, undergraduate or postgraduate research project). NGO research is
acceptable only if the references used meet academic criteria. Co-authored publications should not be
included.

Date Title Description

EMPLOYMENT HISTORY (continue in separate sheet if necessary)

Please give details of recent employment and / or professional experience. All applicants should
complete the following section or attach a supplementary sheet giving relevant details.
Date Nature of work and position held Name and address of employer and
From To nature of organization
ON ATTACHED SHEETS PLEASE DETAIL

1. RESEARCH STATEMENT
The research statement will detail the project the applicant is interested in undertaking for
his/her PhD thesis. The research statement will provide the background to the research topic; it
will also demonstrate an analysis of the issue, and potential research methods to examine this
issue. Note that the student may change their research topic during their study in the Program. This
statement should be about 5-8 pages.

2. PERSONAL STATEMENT
Please describe your related experiences in human rights field. Include all the full time/ part time
professional experiences and volunteer works. Please give reasons why you wish to undertake the
PhD program. This statement should be about 1-2 pages.

ENGLISH LANGUAGE COMPETENCE

Is English your first language? Yes

No (if NO please answer the questions below)
Have you been educated using English as the language of instruction? Yes No
(if YES, for which study or degree…………………………………….)
Please attach formal English language qualifications (e.g. TOELF, IELTS) and the marks you have
already obtained. (Attach test result).

REFERENCES

We request two confidential referees familiar with your academic or professional work. These
people must supply a referee directly to the program by email. The referee’s form is attached to
this application form. Below, please supply the names and addresses the two referees. Please send
the form to your referees yourself.

Referee 1 Referee 2
Name: Name:
Position: Position:
Address: Address:

Tel: Tel:
Email: Email:
FINANCE/SCHOLARSHIP

How would you finance yourself at Mahidol?

Self / Family Employer
Other Scholarship Name of Scholarship ……………………………………
Have you obtained the scholarship yet? Yes No
In the absence of a scholarship, will you be able to meet the cost of your proposed course?
Yes No

PLEASE CHECK YOU HAVE ENCLOSED ALL THE RELEVANT DOCUMENTS WITH YOUR
APPLICATION:

Completed application form, with photograph affixed

Academic transcript of completed University degrees (Bachelor's and Masters)
English language test certificate (for non-native speakers)
Curriculum Vitae
Research Statement and Personal Statement
Have contacted referee’s and sent them the Reference Form

Note: All of these attachments are compulsory. We cannot approve your application unless
we have all the above material.

I hereby apply for admission to Doctor of Philosophy Program in Human Rights and
Peace Studies (International Program) at Mahidol University and confirm that the
information provided above is correct to the best of my knowledge.

…………………………………………… ………………………………
…..
SIGNATURE DATE

Successful candidates will be contacted via email or fax.

 REFERENCE FORM

Dear Referee,

Can you please fill out this form and send it to the Center for Human Rights Studies and Social Development
by email (preferred), or mail. This form is confidential and should not be seen by the applicant.

1. Name of Applicant: ……………………………………………..……………………………

2. I have known the applicant for …………………………(years)

In the following capacity…………………………………………………………………………

3. In the box below rate the applicant’s academic abilities. Please tick the appropriate box:
Top 10% Above Average Below Poor Don’t know
Average Average
Academic ability
Written expression
Oral expression
Research ability
Ability to work
independently
Critical analysis
Motivation
Knowledge of human
rights and/or peace studies

4. Overall how would you rate this student

top 10%
top 25%
average (between 40-75%)
below average (below 40%)

5. How would you rate the applicant’s proficiency in English?

…………………………………………………………………………………………………
6. Please attach one page comment on the applicants suitability to the program, and to undertaking
a PhD. In particular, we are interested in your assessment of the applicants ability to design and
undertake a large research project, requiring a high standard of theoretical and critical skills, as
well as very good written expression. Please attach this to the form.

7. Referee’s name: ………………………………………………………………………………

Position: …………………………………………………………………………………………
Institution: ………………………………………………………………………………………
Telephone: ………………………………………………………………………………………
Email: ……………………………………………………………………………………………
Signature: ………………………………………………………………………………………

Please send this form and the attached comments to:

CENTER FOR HUMAN RIGHTS STUDIES AND SOCIAL DEVELOPMENT
Graduate Studies Building, Mahidol University
Salaya, Phutthamonthon, Nakhon Pathom, 73170 THAILAND
Tel: 66-2-4414125 ext. 400, 401 Fax: 66-2-8892151
Email: chariya_bunto@yahoo.com, ohrsd@yahoo.com, admin@humanrights-mu.org