Ba. eft?" YR` *4

BOYTE
DA! HOC Y DUVC
THANH PHO HO CHI MINH
LONG HOA xA. HOI CHU NGHIA VIET NAM
DOc lap - Tkr do - Hanh pink
Tp. 1-Td Chi Minh, ngay inhane nam 2014
Kinh giri:
46:a.
A/RI
Thuv hien theo tinh thAn cong van s6 3231/BNG — ASEAN cua Bo Ngoai
giao ngay 18/9/2014 ve vi& meei tham gia khoa ciao tao trong khuon kh6 "Tuyen
bei sang kin mang lueri cac trtzerng Dai hoc Y Dong Nam A", Phong Hanh chinh
Ttmg hop kinh de nghi cac Khoa, dun vi cu. nguoi tham gia khoa ciao tao ngan han
tai Trtrong Y thuOc Dia hoc Mahidol (Brih vien Sirijai). (Tai. Rti kern theo)
Danh sach gtxi ve phong Ranh chinh T6ng hop trong ngay 01/10/2014.
Tran trong cam un./.
TL. HIEU TR1UbNG
Ba. eft?" YR' *4
BO NGOAI GIRO
s6:
CONG HOA XA HO CHU NGHIA VIET NAM
DOc 14p — Tiy do — Hanh phtic
/BNG-ASEAN
V/v mai tham gia khoa dao too
trong khuon kho "Tuyen bo sang
Id& mang luoi cac trtrang Dai
Ha N0i, ngay Ag thong 09 nom 2014
• 'ion! Ira- •
BO Y
D
S6' 4qf
0-0?
itc;
inh
Y t6
711c
N
Chuy6n
o goai giao Thai Lan thOng bao Dai hoc Mahidol,
cho
bac sy, cac nuac Campuchia, Lao, Mi-an-ma va Viet Nam tham gia khoa dao too
ngan han tai Trtrong Y thuOc Dai hoc Mahidol (Benh vien Sirijai). Khoa dao too
nay nom trong khuon kho "Tuyen WO sang ki6n mang ltroi cac trtiong Dai hoc Y
DOng Nam A" nham to ca hOi trao dOi kinh nghiem ve giao duc, nghien druva
sire khOe Ong dong gifra cac trtrOng y quOc te, gOp phan dua giang day , y
duvc va cham sOc,sirc khoe cong (long
cac nuck ASEAN ngang tam quOc te,
htrOng COng dung ASEAN.
BO Ngoai giao xin g ri kern this mai, cac tai lieu lien quan va de nghi Qu)',
Ca quan xem xet cir nguad tham gia khoa dao too.
BC) Ngoai giao rat mong nh4n duot cong van tra led cila Q4 Ca quan
trucc neav 6/10/2014 d6 thong bao cho Thai Lan va ti6n hanh cac thu tuc lien
quan.
Xin chan thanh cam an su hop tac cua Qu)'T Co quan./.
Noi
- Nhtr teen;
- Ltru: HC, ASEAN.
BC, TRUVING
G VI,1 ASEAN
A
Nguyen Tien Minh
No. 1503.2/ 4qa0
The. Ministry of Foreign Affairs presents its compliments to the Embassy of the
Sotialitt Republic: Of Vietnam and has the honour to forwagl herewith the offer on 'Rd*
Scholarship for ASEAN Doctors, an international short-term training course entitled
"Declaration of the Southeast Asian Medical Schools Network initiative supported by the
Faculty of Mecncine of Mahidol University (Slitraj Hospital). Details of the scholarship and
course information can be found in the attachment.
In this connection, it would be appreciated if the Embatsy tould kindly
disseminate the said information to authorities concerned and relevant agencies for their
interested applicants in its country.
The Ministry of Foreign Affaip avails itself of this opportunity to-renew to
the Embassy of the So_dialist Republic of Vietnam the assurances °fits highest consideration.
Enclosure: As stated.
The Embassy of the Socialist Republic of Vietnam,
BANGKOK.
1YIAIIIDOL UNIVERSITY
Oiew /grief
Siriraj Scholarship for ASEAN Doctors
at Faculty of Medicine Siriraj Hospital, Mahidot University
Bangkok, Thailand
Fac.ulty Of lvledicine Siriraj Hospital, Mahidot University, arranged "The first-ASEAN Deans' S4rnrnit
Connecting ASEAN Medical Schools towards One COmrnunity" during 17 - 19 Stepternber 2012 atrirctilly
of Medicine Siriraj Hospital.
The First .ASEAN Deans' Summit Connecting ASEAN Medicat sdxoot towards One Community"
has been arranged with the objectives to promote collaboration among leading 'medical schools in the
ASEAN region to leverage medical- education and health system towards internationat.Ocellence anc, to
tie prepared to work as one community by 2015. Furthermore, Deans and Rectors of VS:ASEAN countries
agreed to sign 'Declaration of the Southeast Asian Medical Schools. Network :Initiative". Therefore,
Faculty of medicine Siriraj Hospital, Mahidot University, initiated the declaration byproviding scholarships
for Doctors from Cambodia, LAO .PDR, Myanmar. and Vietnam (CLMV) to, train at Siriraj Hospital, this is to
provide :a great opportunity to exchange experiences in educations, research, and .public hearth with many
international medical institutes, to strengthen and to promote the network of medical schools in the
future.
Objectives
1. Providing an opportunity to doctors from Cambodia, LAO PDR, Myanmar, and VietnArri .(0-10V)
which are a member of ASEAN community to attend international short- term training towSet at
the Faculty of Medicine Siriraj Hospital, Mahidot University.
2. Exchanging experience and knowledge between Thai doctors and international doctors within
ASEAN community
3. Promoting ASEAN collaboration network
Scholarship Details
L This scholarship belongs to Faculty of Medicine Siriraj Hospitat -to the doctors from alviV
countries.
2. The scholarship is provided for those who wish to attend international short-term training courses
at Faculty of Medicine, Mahidot University, for a period of 3 months.
3. The scholarship wilt cover an allowance of 30,00.3 baht for a 3-month period and Siriraj dormitory.
4. Air fare, living expenses, health and liability insurance and all the other financial obligations are to
be borne by each CLMV doctor.
I 1Pa o a.
ou'auficAtion of APPLicatIts
1, 'Graduated with a medical school degree (MD or equivalent)
2. Must be 'a candidate from CLMV countries (Cambodia, Laos PDR, Myanmar,. and Vietnam)
3. Have good commands in English language skills
4. Must be selected by his/her University, Ministy of Foreign-Affairs , or Ministry of HeAlth ;prict
Embassy
Application. accuments;
1. AppliatiOn form can be downloaded from: http://www1si.mahidotac.thArtoel
2. A letter of personal statement
3. Cuniculurn Vitae with a recent photo (ndt morethan 4 morith0
4 Certificate of graduation with MD degree or equivalent
t. A Recommendation letter from Dean or Director
Dea dllne
The application Mt
be reviewed twice a ,year. Please submit the application form with the:teOuired
cloalmeftprior to .31 October 2014 for the first round and 28 February 2015 for the second round.
Retritii(t
Please read this application detail simultaneously. Some courses may need to indicate the period of be
study upon your request.
Coordinator
Mrs. Jalta Pengpreecha
Miss Korboon Petchrueangrong
international Relations Officer
DiViston of International Relatic.ns
Faculty of Medicine.Siriraj Hospital
Mahidot University
Erna a: siiroortialitdoLacth
21V a e
dc.
Pleaseattach recent
ci' ' ;1': .
1 OA 14
4.:1
.*+. 'af '0,/
photograph here
-5ii;.;i4is.'"
tvIAHIDOL UNIVERSITY
Since 1888
APPLICATION FORM
SIRIRAJ SCHOLARSHIP FOR ASEAN DOCTORS
AT
FACULTY OF MEDICINE SIRIRAJ HOSPITAL
MAHIDOL UNIVERSITY, BANGKOK, THAILAND
Ptease answer each question ctearly and completely. Detailed answers are reqUired to ensure WO most
appropriate study arransernents.
i. PERSONAL DATA
1) First name
2) middle name
'1)Farrtilynarne
2) City and country of birth
Date of birth
Nationatity
Age
sot
Passport number
issued date
Expiry date
Marital status
Nurr)ber.of Cattegr)
J
Office tetephone:
3)'Office. address:
Office fax:
Home telephone;
4) Home address:
Home fax:
•
5) Eniail contact:
6)Name and address of person to be notified in case of emergency
Retatidtaship::
Office tetephohe
Email:
-
.-
-1
2. LANGUAGE. ABILITY
1) For language (s) other mother tongue enter below the 1 Understanding of spoken Languages
appropriate letter from the code system at right to indicate your A : i understand at the levet of university instruction
B : I understand at the levetj ofj Normal conversation
level of skill,
C : I understand simple daily usage
Write
Language
tj
-nclerstand Speak
Read
Speaking ability
A : I speak at the levelj of university discussion
B : I speatwe enough toJ engage In norrrrat conversation
C : I speak adequat4to.meet Limited sociak'needs
Reading ability
A : I can read without difficulty all tedinidat rnaWrial in
my
field
B : i can read with some diftruttyalttechrticaLmateriatin
my field
,
C: I can read newspaper articles ar d ‘tirAllarcrliatatial
Writing ability
A : i can write teChnicat papers and reports:-easily
B : I can write technical reports with some difficulty
C : I can write ordinary correspondence
3. EDUCATION
Dates
from / to
1
Institution
(name, city and country)
Qualification
obtained
Major fields Of study
Language used
4. EMPLOYMENT RECORD
Beginning with your preSent post, provide precise details of your responsibilities and activities and describe what you are
doing_ Give particular attention to any duties-which relate to your qualifications for this sCholarship or to you need for the ,
further study proposed.
1) Present post
List your _specific duties
To:
From :
Title of your post :
Name And 40: ress of tmptoyer:
Name andaddeess of supervisor
TYPe of emPtiVittittt:
■ Pubtit service
❑ Private
❑ Teaching
❑ Research
2) Previous post :
From I
Trtle of your post :.
❑ Other
To;
Name and address df,employer:-
Name anct.tildfets of s:uperyison
Type of employment:
■: public service
■ Private
❑ Teaching
■ Research
❑ Other
List your specific duties
5. SELEC i ED COURSES OR SUBJECT OF STUDY
1)Selected cout,seS4t.Subject of study
2) Study objectives :
3)Based _or) wur objettlyes as stared above, please complete The following statement.
On cokititetion of nly.study-At faculty of Meclitine $tiiaj Hdspital, Mahicidt UniversitibitTOpe to be ablt.tO :
.
....
t.
4) Start.of study : please indicate when you Witt be available to start your -selected short training .course
(Some'. courses may need to indicate the period of the study upon your request.)
6. COMMrTMENT
i certify that the above statements are-correct and complete to the best of my knowledge.
Signature
Date
...
-
:A