2020 Application Form Master ITC

INSTITUTE OF TECHNOLOGY OF CAMBODIA
GRADUATE SCHOOL
Application Form for Master’s Program

Academic Year: 2020-2021
Please choose a program* Type of Diploma*

 Master of Materials and Structures  Regular Degree
☐ Master of Water and Environmental Engineering ☐ Double Diploma
☐ Master of Agro-Industry
☐ Master of Mobile Technology Will you apply for a scholarship?
☐ Master of Energy Technology and Management (if yes, please specify) *
☐ Master of Intelligent Mechatronics ☐ No
☐ Master of Transport Engineering ☐ Yes LBE Program
Registration
☐ 1st registration M1
 1st registration M2
☐ Re-registration _______
* please see details of each program in the leaflet for the possible types of
diploma and scholarship via this link https://bit.ly/itcmaster2020-21
1 Particular of Applicant
Family name: MONG Given name: Phanna_

Marital status: Single Gender:  Male ☐ Female Date of Birth: 19/April/1996Place of birth:
KampongChhnang I village, Bavel commune, Bavel distict, Battambang Province.
Country of Birth: Cambodia Nationality: Cambodian_
Current Contact Information

Address: KampongChhnang I village, Bavel commune, Bavel distict, Battambang Province.
Postal code: 855Province/City: Battambang Country: Cambodia
Phone number: 078 424 966 Email Address: mongphanna@gmail.com
Secondary Contact Information (We will use this address if we cannot reach you at the first address)
Contact person’s name : Hem Noy Address: Battambang
Postal code: 855Province/City: BattambangCountry: Cambodia
Phone number: 012 366 541 Email Address: __________________________________________
Version 03-07-2020 Page 1 of 3

2 Educational Background (List all colleges and universities previously attended, if applicable, in chronological order. Use a
separate sheet for additional information.)
Have you graduated from ITC?  No ☐ Yes

If yes, please state year of completion : ____________ Major: _________________________________________
High School Diploma

Grade: D Year: 2014 Province/City: BattambangCountry: Cambodia
Educational Institution: Bavel high school
Higher Education
a. Institution, city and country: University of Battambang, Cambodia
Major/Field of study: Civil engineering
Period of study (mm/yyyy-mm/yyyy): 10 /2014 - 10 /2019 Graduation date (or expected): 11/2019
Degree obtained or expected: Bachelor degree of civil engineering
b. Institution, city and country: ________________________________________________________________
Major/Field of study: ______________________________________________________________________
Period of study (mm/yyyy-mm/yyyy): _ _ /_ _ _ _ - _ _ /_ _ _ _ Graduation date (or expected):_______________
Degree obtained or expected: _______________________________________________________________
3 Foreign Language Proficiency

Excellent Good Fair Poor
English Reading ☐  ☐ ☐
Writing ☐  ☐ ☐
Certificate: Level 07
Delivery date: __________ Speaking ☐  ☐ ☐
Listening ☐  ☐ ☐
Excellent Good Fair Poor
Other language Reading ☐  ☐ ☐
(French) Writing ☐  ☐ ☐
Certificate: A2_ Speaking ☐  ☐ ☐
Delivery date: __________ Listening ☐  ☐ ☐
4 Work Experiences
(A) List your work experiences in order
From To Institution/Location Title/Position
01/08/18 01/02/19 N K R S Co LTD / Battambang Province. Site engineering

_______ _______ _____________________________________________ ______________________
_______ _______ _____________________________________________ ______________________

(B) Describe your work experiences related to this proposed study program
My work base on structure of building. The process of this work is to construct the referral hospital building. Focus
on the shear wall. I think that my internship is related to the study program, Master of Materials and Structures._
5 Documents* required to be submitted (only in Khmer, English or French):
a. CV with a photo ............................................................................................................................ 1 copy

b. Recent photos 4x6 (with name label on the back side) ................................................................. 6 copies
c. Baccalaureate or equivalent diploma *.......................................................................................... 1 copy
d. Bachelor degree, engineer degree or equivalent diploma *........................................................... 1 copy
e. Complete transcripts (1st year to final year) of obtained degree * ................................................. 1 copy
f. Certificate of language proficiency ............................................................................................... 1 copy
g. Enclosed recommendation letters (at least one from professor/lecturer
and other letters from supervisor/ professor/lecturer. please fill in the given form) .................... 1 copy
h. Motivation letter ........................................................................................................................... 1 copy
i. Additional documents required by scholarship application
* All submitted documents must be certified copies.

If this is a re-registration, please submit only the updated documents.
6 Applicant’s Declaration
I declare that all information provided is true, complete and accurate to the best of my belief and knowledge, and
that I have not willfully suppressed any material fact.
Signature: ____________________________ Place: _______________________, Date: ___ / ___ / 2020
THE COMPLETED APPLICATION FORM AND THE REQUIRED DOCUMENTS MUST BE SENT TO
GRADUATE SCHOOL OF ITC
A single pdf file (except the recommendation letters) via Email

and then a hard copy to our mailbox
Deadline: August 31, 2020

Incomplete applications are inadmissible.
Email: graduate@itc.edu.kh
Mailbox: Room B-110, P.O.BOX 86, Russian Federation Boulevard, Phnom Penh, Cambodia

2020 Application Form Master ITC

Uploaded by

Copyright:

Available Formats

2020 Application Form Master ITC

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2020 Application Form Master ITC

Uploaded by

Copyright:

Available Formats

INSTITUTE OF TECHNOLOGY OF CAMBODIA

Application Form for Master’s Program

Please choose a program* Type of Diploma*

Family name: MONG Given name: Phanna_

Current Contact Information

Version 03-07-2020 Page 1 of 3

Have you graduated from ITC?  No ☐ Yes

High School Diploma

Degree obtained or expected: _______________________________________________________________

3 Foreign Language Proficiency

01/08/18 01/02/19 N K R S Co LTD / Battambang Province. Site engineering

Version 03-07-2020 Page 2 of 3

5 Documents* required to be submitted (only in Khmer, English or French):

a. CV with a photo ............................................................................................................................ 1 copy

* All submitted documents must be certified copies.

Signature: ____________________________ Place: _______________________, Date: ___ / ___ / 2020

A single pdf file (except the recommendation letters) via Email

Deadline: August 31, 2020

Version 03-07-2020 Page 3 of 3

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Signature: ________ Place: _, Date: _ / ___ / 2020