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NRCT-01Project I.D. ………………………3 PHOTOSOffice of the National Research Council of Thailand (NRCT)Office of International Affairs196 Phaholyothin RoadChatuchak, Bangkok 10900, ThailandPhone: +(66-2) 940-6369, 579-2690 Fax: +(66-2) 561-3049Website : www.nrct.net, www.nrct-foreignresearcher.orgE-mail : webmaster@nrct-foreignresearcher.orgAPPLICATION FORM FOR PERMISSION TO CONDUCT RESEARCH IN THAILANDPlease type or print in EnglishRESEARCH PROJECT TITLE: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………PART 1 PERSONAL INFORMATION1.1 Name: …………………………………………………………… Sex: [ ] Male(First) (Middle) (Last) [ ] Female1.2 Permanent address: ……………………………………………………………………………………………………………………………………………………………………………………………………………….………………Postal code: ………………………………… Country: ………………………………………………………..Phone: ………………………………………1.3 Current employer: ……………………………………………………………………………………………………Address: ……………………………………………………………………………………………….………………………………………………………………………………………………………………………….……………..Postal code: ………………………………… Country: ………………………………………………………..Phone: ………………………………………. Fax: …………………………………………………………….E-mail: ………………………………………………………………………………………………………………..Job title: ………………………………………………………………………………………………………………Job description: ………………………………………………………………………………………………………1.4 Passport informationNationality: ………………………………. Country of citizenship: ………………………………………..Passport number: ………………………… Expiration date: ……………………………………………….1.5 Family information:In case of being accompanied by family, provide the following information. Otherwise, skip to 1.6.Family: 1) Name: ……………………………………………………………………………………………………Nationality: ………………………….. Country of citizenship: ……………………………..Passport number: ……………………. Expiration date: …………………………………….
NRCT-012) Name: ……………………………………………………………………………………………………Nationality: ………………………….. Country of citizenship: ……………………………..Passport number: ……………………. Expiration date: …………………………………….1.6 Highest degree earnedDegree Major/Specialization University Graduation year1.7 If the applicant is a student, give the degree sought. Otherwise, skip to 1.8DegreeSoughtMajor/Specialization University Expectedgraduation year1.8 Previous research in Thailand (if any, list the most two recent visits):Year Length of stay Submission of complete reportPART 2 RESEARCH PROJECT INFORMATION2.1 Research subject : ……………………………………………………………………………………………………- Research discipline : (More than one discipline can be ticked.)[ ] Physical Science and Mathematics [ ] Law[ ] Medical Science [ ] Political Science & Public Administration[ ] Chemical and Pharmaceutical Sciences [ ] Economics[ ] Agriculture and Biology [ ] Sociology[ ] Engineering and Industrial Research [ ] Information Technology & Communication Science[ ] Philosophy [ ] Education- Research field : Please specify (e.g. Tourism, Environment, Biology, Archaeology , Anthropology)…………………………………………………………………………………………………………………………………..2.2 Research duration: From ......................... month/year To...........................month/year2.3 Funding agency name:…………………………………………………………………………….………………Grant number: ……………………………Funding period: …………………………………..Funding agency address: …………………………………………………………………………………………………………………………………………………………………………………………………………………….Postal code: ……………………………….Country: ……………………………………………
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The Nippon Foundation Fellowshipsfo
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1. PREPARATION PRIOR TO ARRIVAL IN
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Fax: 66-2679-2208http://www.kln.gov
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1-3-2. Suksitniwet International Ho
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For more information, please call 0
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Ms. Napat Tangapiwut (Puk), Assista
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For the Fellows accompanied by thei
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the API Execu tive Committee. The F
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