CENTER FOR HUMAN RIGHTS STUDIES AND SOCIAL DEVELOPMENT

(CHRSD)
Graduate Studies Building, Mahidol University
Salaya, Phutthamonthon, Nakhon 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
The Master of Arts in Human Rights (International Programme)

Please complete all four pages and tick boxes as appropriate. Please return
The complete form, with a passport-size photograph affixed and all other Passport-size photo
supporting documents, to the Center for Human Rights Studies and Social
Development (CHRSD) 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: ……………………………..………..…TITLE ……………………...............................

GENDER: Male Female

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

(day / month / year)

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

PERMANENT ADDRESS: CORRESPONDENCE ADDRESS:

(if other than the permanent address)

Email: Email:
Tel: Tel:

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Fax: Fax:

ACADEMIC HISTORY (you may separately attached details)

Please enter, in chronological order, details of all degree or diploma programmes attended since leaving
school. Please supply certified copies of your academic transcripts or certificates with English translations.
Year of
Qualification or
Attendance Institution/Country Study Programme
Degree Acquired
From To

Please give details of research and publications you have undertaken. In the “description” please state the
type of publication (for example dissertation, undergraduate or postgraduate research project, NGO
research); and state if you were the individual author or with a research team.
Language of
Year Title Description
Publication

EMPLOYMENT HISTORY (you may separately attached details)

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Please give details of recent employment and/or professional experiences.
year
Name of organization or employer Position
From To

PERSONAL STATEMENT

On attached sheets, please write your personal statement of interest 400-600 words long, describing in
detail:

1. Your special academic interests

2. Your purpose and objectives in undertaking this study programme
3. Ideas for your master’s thesis in human rights studies
4. Your related experiences in the field of human rights, including full-time and pat-time professional
experiences and volunteer works.

ENGLISH LANGUAGE PROFICIENCY

* Is English your first language? Yes

No
* If English is not your first language, please indicate the result(s) of English proficiency test(s) you have
taken (TOEFL or IELTS), the date(s) taken, and the score(s) you have obtained. (An official certificate of
each test must be attached).
Test Date of Test Score

REFERENCES

We request two confidential references from persons of high academic or professional standing who are
well acquainted with you and your academic and professional work. Each of the referees must fill in the
reference form (which can be found at the end of this application form) and send it directly to CHRSD. The
referees may submit their form by email. Below, please give details of the two referees. Please send the
reference form to your referees.

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

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Institution: Institution:

Email: Email:
Tel: Tel:
Fax: Fax:

FINANCIAL DETAILS

How would you finance yourself at Mahidol?

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

I hereby apply for admission to the Master of Arts in Human Rights (International Programme) 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.

CHECKLIST FOR YOUR APPLICATION

Completed the application form

Affixed a photograph
Signed and dated the form
Attached personal statement
Attached academic transcript(s)
Attached English language test certificate(s)
Attached separate details of academic and/or employment history (if any)
Contacted the referees and send them the reference form (the form must reach CHRSD no later than 15
November 2009 for the first round of application, and no later than 31 January 2010 for the second round.)

SOURCE OF INFORMATION ABOUT THIS PROGRAMME

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To help us with our promotion activities, please indicate how you were informed about this programme of
study at Mahidol University.

Advertisement in …………………………………………........................(please name newspaper/journal)

Internet …………………………………………..……………………….(please specify)
Mahidol University prospectus
Our students or alumni
Our faculty members or supporting staff
Others (please specify) …………………………………………………..

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 REFERENCE FORM

Dear Referee,
Please fill out this form and send it directly to the Center for Human Rights Studies and Social
Development at Mahidol University by email (preferred) or mail at the address below.
1. Name of applicant: ……………………………………………..…………………………………………..
2. I have known the applicant for …………………………(years)
In his/her capacity as…………………………………………………………………………………………...
3. In the box below rate the applicant’s academic abilities. Please tick the appropriate box:
Above Below
Top 10% Average Poor Don’t know
Average Average
Academic ability
Written expression
Oral expression
Research ability
Ability to work
independently
Critical analysis
Motivation for study
Knowledge of human
rights

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 spoken and written English?
………………………………………………………………………………………………………………….

6. Please attach one page comments on the applicant’s suitability to the programme, and to undertaking a
master’s programme. In particular, we will appreciate your genuine assessment of the applicant’s ability to
design and undertake a 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: ……………………………………………….……Date………….………………………………

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