SEDUCATION AND CULTURE ATTAGE’ FAX NO. ie602551269 O01 MAHIDOL UNIVERSITY Ace AGS Sirraj Scholarship for Doctors fram ASEAN and Developing Countries Faculty of Medicine Siraj Hospital, Mahidol University, Thailand Fiscal years 2017-2019 (3 years) -Aécording to Faculty of Medicine Stiraj Hospital has implemented Sua) Scholarship for ASEAN Doctors (2013-2015) to CLM countries inclucing Cambodia, Laos POR, Myanmar and Vietnam in order to ‘create 2 collaborative network and promote an exchange of doctors within ASEAN countries for further, taining and gelring experiences in terms of reseaich, medical services, and health system of Thailand, The faculty received significant cooperation from all departments as well as inquires from number of ASEAN doctors who have expressed their interests in the project, continuously. In adherence to the Faculty strategy In promoting visbilty and intemational recognition, Preparation fer changes in ASEAN Economic Community (AEC) as wetl as developing the cooperation with other developing countries in the needs oF medical asstance, for instance, Sif Lanka, Bhutan and Nepal, therefore, Intemational Relations OWislon has proposed Siraj Scholarship for Doctors from ASEAN and Developing Countries Project 2017 - 2019 (3 years) in otter to expand its application of original CLMV countries to cover other ASEAN countries as well as other developing countries in Asa, The ebjectives of ‘he project ate to enhence cooperative network and improve Intemational recognition ef the faculty ‘hich are In Une with the stated strategy of “Promote International Visiity and Globat Presence”, Duration Fiscal years 20172019 (3 years) Objectives — To provide an opportunity ans support those doctors in ASEAN and other developing ‘countries further studies and training to gain more experiences in vatious oreas of studies within the Faculty for a period of 1-3 montns 2, To encourage and strengthen collaborative network at ASEAN and Intemational levels 3 To mate the Faculty more visble in education, research and medal services as a leading ‘medical institute in ASEAN and the global arena Sra Sehekarship for Dacor rom ASEAN and Caveloping Counts, scal years oF 2017-2019 ‘venusFROM :EDUOATION (ND CULTURE ATTACHE | FAK NO. 146622551269 ODL 12 Jul. 2016 11:05" PO MAHIDOL UNIVERSITY hee 1888 ‘The Embassy ofthe Republle of indonesta : 600-602 Petchbur Road Patchatevt, Bangkok ae ; Theland 10400 Be tons 7 Ref. no: 04/2016 Date: 29 June 2016 Attachment: 1, Siraj Schotarship for Doctors from ASEAN and Developing Counties Explanatory 2, Application form (SIAD-1) 3.Ust of shert taining course Dear Sir/Madam, it ls among the top prionties that the Faculty of Medicine Siraj Hospital, Mahklol University ascends to the recognition of international standards. Qur goat is to become one of the most prestigious universities in the world, with up to date facilities end capable megical personnel fully prepared to meet the groning demands of high quality healthcare of the ASEAN community by 2015, The Faculty of Medicine Siraj Hospital, Mahidol University has strategy in promoting visllity and international recognition as well as developing the cooperation with other developing ~ountries in the needs of medical assistance, therefore, Intemational Relations Division has proposed Sil) Scholarship for Doctors from ASEAN and Developing Counties Project 2017 - 2019 (3 years). In this regard, we would appreciate your kind assistance in promoting the Intemational Short-Term Training Courses to the Miristy of Foreign Affairs and the Ministry of Public Health in your country. Your coordination in processing the doctors’ profile proposed from each country can be conducted via email ‘Thank you for your kind coordination. Should you need further information, please do not hesitate to Contact Us at israleerail corn. Professor Prasit Watanapa, MD, PhO. FRCS, PACS Dean, Faculty of Medicine Siraj Hospital Mahidol University Bangkok, Thailand PivoeCountries eligible for Training and Scholarship + Indonesia, Philippines, Sf Lanka, Bhutan and Nepal Budget = Budget allotted to each grantee from indonesia, Philipines, SH Lanka, Bhutan and Nepal 10,000 baht/month for 1-3 months, maximum of 30,000 bah¥/person ~All applications are responsible for tuition fee and on-campus accommadetion fee of private accommodation on thelr own = fir fare, living expenses, health and lability insurance and all the other financial obligations are to be borne by each ante = Duration ofthis project covers three fiscal years of 2017-2012, ‘uallfication of Applicants Graduated with a mecical degree (MO or ecuivalent) 2. Must be a candidate from Cambodia, Laos FOR, Myanme, Vietnam, Indonesia, Philiopines, St Lanka, ahutan and Nepal ONLY, depending on the category of scholarship apptiog With good commands in English language sls 4, Must be proposed by the appilcant's institute, Mistry of Foreign Affss, Ministry of Health, or the Embassy of each country Application Documents ‘Apppication form (SIAD-1) Personal statement Curriculum Vitae ‘A recent photo (not more than 6 months) CCerticate of gracuation with MD degree or equivalent, ‘Arecornmendation (etter ftom Dean or Director ofthe applicant's institute or the authorized person Deadline ‘The application wll be reviewed every 4 months, Please subxnit the application form with the required documents accoraing to this following information: = 1" round prior te 31 September 2016 + 2° round prior to 34 Janwary 2016 Suing pile te 3f May ZOE - a Coordinator Mrs, Janiea Pengpreecha Miss Korooon Petehrueangrong International Relations Officer Division of international Relations ulty of Medicine Siraj Hospleal Mahidol University Emel: siro@mahidoLac.th, isiajegmalicom Tek: 66 2419 9465-6 ext. 102/106 sn geMAHIDOL UNIVERSITY Pree 8S APPLICATION FORM Siraj Scholarship for Doctors from ASEAN and Developing Countries Faculty of Medicine Sirira Hospital Mahidot University, Thailand Please attach recent photograph here ——— Please answer each question clearly and completely. Detailed answers are required to ensure the most appropriate study arrangements. zt 1. PERSONAL DATA Fithawe Wide rae sniy tate Gay ond county Date of bth Tatonalty Tis See . | | Toad bre Passport number issued date: ‘| Expiry dates Marital status: | Number of Children: Dice oder Giice telephone [orem are ade Home telephone: rere rae oo | BYE contact S Niobe phone 6) Name and address of person to be notified in case of emergency ‘Office telephone: Mode phone: etationshig: . ema: . Sela] Stholarihip for Goctors from ASEAN andl Developlag Counties, cal years of 2017-2019 PagetSIAD-L 14, EMPLOYMENT RECORD Begining wth your present past, povida pretea detale & your responsbilties and activites and describe what you da Gve particular attention to any duties related to your qualifealions for this scholarship cr to your need forthe stucly proposed. 1) Present post From To: Ui your speofe cuties: Tile oF your post: Name and address of employer: ‘Name and address of supervisor: Type of employment: CI fulvtine DD parttine Crate senice Clenate Dotrer Ci teacring Ch Resesren Ti ciinical service C1 Pre-ctinical service Previous post: From: Te Tis your specie dutis Title of your post Name and address of employer: Name and addrass of supen/sor Type ot empioyment: CF) futltime £1] parttime Clrubtieservice Ol private 0 other Cteaching C0 esearch Tatiricet sentce C1 Proctinicl service ‘St Scholarship for Doctors form ASEAN and Devaloping Counties, cal year of 2017-20 Page 8FROM :EDUCATICN PND CULTURE ATTACHE * Fax NO, 148622551269 eat 12 Jul. aie Anr1zPH P? List of shor traning course for Siraj Schetarshia or Dactors from ASEAN ene Developing Countries Ne. Prograrn Department T Superson Period mons 1 [Pan Manegemere [aresthestogy [Asce. Prof Wanna Sirojanalak 3 2 [Thal Tectonat Medicine Center of Appled Thal Tadtonal medicine |Astoe: Poh Tawee Lachopand 1 3 |feirTranspartation —Owrnatology lasst. Pro. Rattapan Thuangtone t [Santer lbemataiosy Prot. Woraphone Wanusiatt 7 5 escent Ow [iedane laste. Prof Natachet Plengvckya 7 [abasic Course IMeaone lasoc. Pot Nonthalee Pauses 3 7 |lssyomeapy Obstetrics Gynecology Jssoc, Prof. Singpetch Suksompong t 8 fear bstetes-Gynecctogy |ssoc. Prot Rounssn Choavaratana 7 9 [oteucome [Opthalmology assoc Pot. Ankara Methestainat 2 10 [Spars Medicine lorthopecdc Surgery rot Panupan Songcharoen 7 1f [Nematopathology Pathology Prt Sanya Sukparichnont 3 72 [Thalassemia "Yredate [assoc Prot Vie Virals 3 43 |clirical Pharmacology Pharmacology [ssoc, Prof. Supornchel Kongpatanahal Jsst Prof. Somruedee Chatscharoenkul 14 |nterventiondt Radiology [Radiology Jssoc. Prof. Anchalee Churojana hs [75 Jretrersaciogy Fadoegy Prof O1asa Chawaipant 1 — 16 |Noclear Medicne fadiciogy lassoc. Prof. Sunania Chew 3 37 |ehabiteton etittadon Medine assist. Proftsanu Karrthomthip 3 ie us suse [x Viroon Chirswangustanakal 3 19 |fney Transplant [surgery ce [Assec. Prof. Chalrong Nuaboong ° 20 |Endovascuts Sugery [Saryey cr Prareok vtrangura 3 21 Btooreank =" [Tanstasom mean = [OF vroje CRsnghotnatane