application form aa mae fah luang uthaiwan go

1

MAE FAH LUANG UNIVERSITY

333 Moo 1, Thasud Subdistrict, Muang District, Chiang Rai 57100, Thailand Tel. (053) 916020-1 ; Fax. (053) 916019; Website: www.mfu.ac.th

Application form for Academic Appointment

For Course/ Program: Health Promotion and Prevention,

Community Dentistry,

Ethic and Dental Professional Development,

Dental Student Quality Development

School of: Dentistry

1. Personal Information

1.1 Name & Surname (Mr/ Ms/ Mrs): Uthaiwan Kanchanakamol

Academic Title (if any): Dr.

Nationality: Thai ; Ethnicity: Thai-Yong

Religion: Buddhist

Personal Identification Enclosed:

Identity card State enterprise ID card

Civil/ military/ police service ID card Passport

Other (please specify)

Card or passport number : 35199-00020-91-0

Issue by: Thai Government ; Expiry date : Throughout life

1.2 Date of Birth: 9 ; Month: May ; Year: 1948

Place of Birth: Lamphun

Country: Thailand

1.3 Fathers Name: Prapan Kanchanakamol

Nationality: Thai

Religion : Buddhist

2

Occupation: Deceased

Mothers Name: Jannual Kanchanakamol

Nationality: Thai

Religion : Buddhist

Occupation: Deceased

1.4 Domicile:

180 Moo2 Yuyen Road, Changphuag

Muang, Chiang Mai 50300

Country: Thailand

Telephone: 0819526103 ; E-mail address:[email protected]

Current Address or Contact Address:

180 Moo2 Yuyen Road , Changphuag

Muang, Chiang Mai. 50300

Country: Thailand

Telephone: 0819526103 ; E-mail address:[email protected]

Single Married Separated

Widowed Divorce

1.6 Spouses Name (if married): Duongporn Kanchanakamol

Nationality : Thai

Religion : Buddhist

Occupation : Research Worker

Contact Address : 180 Moo2 Yuyen Road , Changphuag


Country: Thailand

1.7 Number of Children (if any): 2

Aged: 35 / 20

3

2. Education (tertiary Education only; start from the most recent)

Degree and Academic Distinctions (if any)

Major Institution Year of

Completion GPA

Fellow of Royal College of Dental Surgeons of Thailand

_ Thai Dental Council

2014 -

Diplomate, Thai Board of Dental Public Health

Dental Public Health

Thai Dental Council

1997 -

Master of Public Health International

Public Health

University of Alabama at Birmingham, USA

1989 -

Certificate in Dental Public Health


University of London

1977 -

Doctor of Dental Surgery Dentistry Chulalongkorn

University

1973 -

3. Training (within the last three years) or Other Fields of Education

Program/Course Duration Institution/ Venue Source of Fund

Technology of Participation 1 (TOP 1)

3 days Gerry Roxas Foundation & King Prajadhipoks

Institute/Bangkok

United Nation Development Program (UNDP)


3 days King Prajadhipoks Institute /Bangkok



4 days King Prajadhipoks Institute/Bangkok


Deliberative Democracy 3 days King Prajadhipoks Institute/Bangkok

King Prajadhipoks Institute

The Public Participation 1 week King Prajadhipoks Institute/Bangkok

King Prajadhipoks Institute

Local Government and Civil

Society

1 week International Academy for Leadership

The Friedrich-Neumann-Stiftung

Human Right Promotion at Community Level

10 days Amnesty International & Peoples Right& Freedom Association

The Asia Foundation & USAID

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4. Employment History

4.1 Current Position (if currently employed):

1) Position: Director, Institute for Community Empowerment.

Salary: None, Voluntary position in Not-For-Profit Organization ,

(The social purpose organization serve the public interest)

Employed since: Date: 6; Month: October; Year: 2002

(Total period of 11 years and 9 months+)

Job descriptions:

1) The expert, empowering community people and charities to maximize their impact for social good.

2) The community coach and mentor in health promotion program in marginalized people.

3) The member of team researchers that become a community-based participatory action research team. Working with community organizations, helping to determine what kind of information would be useful, and then learned how to gather it. Because the team is a part of the community, they are trusted by community members; because they share other community members experience, they know what questions to ask and fully understand the answers, as well as what they are seeing when they observe.

4) The community facilitator, working for a local community, referring and promoting free or low-cost support services to community families.

Name and address of employer/organization:

Institute for Community Empowerment.

Contact Address: 180 Moo2 Yuyen Road , Changphuag


Country: Thailand

Type of business: Social Entrepreneurship

Name of supervisor: -

Reason for leaving: -still serving

2) Position: Freelance Researcher,

Training & Community facilitator,

Training & Community coach,

Training & Community mentor.

Salary: Freelance

5

Employed since: Date: 10; Month: December; Year: 2005

(Total period of 9 years and 7 month)

Job descriptions:

1) Researcher, as Leader in the participatory action research team of Institute for Community Empowerment (ICE) in building community capacity in marginalized groups and hill tribes people namely; Hmong, Karen. Akha, Lahu, Lisu in health promotion by using Appreciative Inquiry (AI),Positive Community Approach, Asset-Based Community Development (ABCD), Social Capital and Strength-Based Community Development as the development tools such as Community Empowerment and Participatory Community Resource Management : A case study of Community Capacity Building for sustaining community development in Hmong villages, Baan Doi Pui, Tambon Sutep, Baan Khun Chang Kian, Tambon Chang Puag, Muang district, Baan Mae Sa Mai and Baan Mae Sa Noi, Tambon Pong Yaeng, Mae Rim district, Chiang Mai province on 2010-2012,funded by Thailand Research Fund(TRF).

2) Training Facilitator and Coach as one who take a more leading role and take a group through an agenda designed to transmit a body of knowledge or a set of skills to be acquired in organization/community, namely: community leaders, local organization leaders, executive organizers, by using community empowerment (CE) and Appreciative Inquiry (AI) as the tools in developing Social Leaders in Department of Health, Health Promotion Office, Dental Public Health Office, Regional Health Centers in Ministry of Public Health, and the Institute for Development and Technology Transfer in Environment, Department of Environment Quality Promotion (DEQP) in Ministry of National Resource and Environment

3) Training Mentor, as a member of the Participatory Action Research team in PAR Study of Social Capital for Sustainable Community Development: The case studies for sustainable development in the communities at Lahu hill tribe, Huay Hea village, Pang Ma Pha district, Mae Hong Son Province; Lisu Hill tribe, Paek Sam and Hin Taew villages, Wiang Haeng district, Chiang Mai province, Thailand on 2011-2013, conducted by the Highland Health Development Center, Department of Health, Ministry of Public Health; as a member of the Participatory Action Research team in the Participatory Action Research on Community Empowerment focused on Dental Health Promotion in Preschool and Primary School Children in Chiang Mai Province on 2011 - 2013, conducted by the Intercountry Center of Oral Health, Department of Health, Ministry of Public Health.

4) Community Mentor, as the leader of the capacity building and mentor team in Community Empowerment in Health Promotion in communities namely: Karen hill tribe, Baan Mae Thor Kee village, Tah Song Yang district, Tak province; Akha hill tribe, Baan Pah Yaa Sai and Baan Ah Yae villages, Praw district, Chiang Mai province, conducted by the Highland Health Development Center, Department of Health, Ministry of Public Health

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Institute for Community Empowerment.

Contact Address: 180 Moo2 Yuyen Road, Changphuag


Country: Thailand


Name of supervisor:-


3) Position: Chairman, the Examination and Certifying Board in Dental Public Health,

And Member, the Royal College of Dental Surgeons of Thailand

The Dental Council of Thailand Salary: None, Voluntary position in Not-For-Profit Organization ,

(The professional purpose organization serve t he public interest)

Employed since: Date: 6; Month: February; Year: 2014

(Total period of years and 6 months)

Job descriptions:

1) Organize the committee of the Examination and Certifying Board in Dental Public Health, The Dental Council of Thailand

2) Executive Board of the Royal College of Dental Surgeons of Thailand.

The Dental Council of Thailand Name and address of employer/organization:

Executive Board of the Royal College of Dental Surgeons of Thailand

The Dental Council of Thailand Contact Address:

Watvidhayawatthana Building

Faculty of Dentistry

Chulalongkorn University

Henry Dunant road

Pratumwan

Bangkok

Country: Thailand




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4.2 Work Experience (start from the most recent)

1) Position: Fulbright New Century Scholar (NCS);

Salary: 120.000 Baht

Employed from: 9 /January /2001 to 8 / December/ 2002

(Total period of 1 year and 11months)

Job descriptions:

1) Conducting participatory action research, Practicing health promotion and strength-based community development through the conservation of indigenous knowledge and traditions of 11 Community Based Organizations in Chiang Mai, Thailand.

2) Engaging in the Fulbright New Century Scholar Program Challenges of Health in the Borderless World.

3) Working with fellow NCS Scholars to transcend national and cultural boundaries to address the most pressing issues of health in both the local and global arena.

4) Helping to create a new global dimension for the Fulbright Scholar Program.


Patricia Harrison, Assistant Secretary of State for Educational and Cultural Affairs, the U.S. Department of State, Washington D.C. / Fulbright Foundation

Country: U.S.A

Type of business: Research Scholar

The Fulbright New Century Scholar Program:

Challenges of Health in the Borderless World


Reason for leaving: Program completion

2) Position: Part time Community researcher, coach and mentor

Salary: Freelance

Employed since: Date: 9; Month: January; Year: 2004

(Total period of 10 years and 5 month)

Job descriptions:

1) Researcher, as one of the participatory action research team in developing King Prajadhipoks Institute Public Participation Program (KPI/PPP) for developing public services toward excellence by people participation. Peoples Audit

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2) Training Facilitator and Coach, as one who take a more leading role and take a group through an agenda designed to transmit a body of knowledge or a set of skills to be acquired in the King Prajadhipoks Institute Public Participation Program (KPI/PPP) in the Peoples Audit training program(KPI/PA), 19 classes.

3) Training Mentor, as one of the participatory action research team in A PAR Study of Social Capital for Sustainable Community Development: A case study for sustainable development in the communities near the electricity generating power plant at Nua-Klong District, Krabi Province Southern Thailand, Publisher or Journal: King Prachathipok Institute.

4) Community Mentor, as one of the research and development team in developing King Prajadhipoks Institute Public Participation Program (KPI/PPP) for developing public services toward the excellence trough people participation. Peoples Audit

in Chiang Rai province.


Research and Development Office

King Prajadhipoks Institute 120 Moo 3

Chaengwattana Road,

Thung Song Hong, Laksi District, Bangkok 10210

Country: Thailand

Type of business: Part time Researcher, facilitator, Coach and Mentor in

The office of Research and Development

Name of supervisor: Dr. Tawilwadee Bureekul,

Director, The office of Research and Development,

The King Prajadhipoks Institute

Reason for leaving: program completion

2) Position: Chairman and Lecturer, Department of Community Dentistry Faculty of Dentistry, Chiang Mai University.

Salary: 32,000 baht

Employed since: Date: 2; Month: January; Year: 1974

(Total period of 26 years and 9 months)

Job descriptions:

1) Lecturer in Oral Surgery courses

2) Instructor in Oral Surgery clinic

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3) mentor & lecturer in Introduction to Community Dentistry; 3rd year dental students

(1978-1990)

4) Lecturer in Dental Public Health; 5th year dental students (1978-1988)

5) Lecturer and instructor in Preventive Dentistry; 6th year dental students (1978-1988,

1990-1998)

6) Lecturer in Dental Practiced Management; 6th year dental students (1978-1988,

1990)



Chiang Mai University

Sutep Road

Chiang Mai, 50200

Country: Thailand

Type of business: State owned


Reason for leaving: pending early retire since 1998

5. Other Positions Held:

2002-present, President, Northern Citizen Association for Community

Empowerment

2013-present Vice President, Khon Yong Association

2004-2011 Senior Editor, the Northern Thai Citizens, Weekly

2000-2001 Chairman, Steering committee, Community Radio Pilot Project,

Thailand Broadcasting Radio, Chiang Mai

2002-2007 Director, Community Radio Station, FM 99 MHz, Chiang Mai.

Voice for Community Empowerment

2001-2002 Research Scholar, Fulbright New Century Scholars Program

(NCS) Challenges of Health in the Borderless World

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1998 Early Retired Government Official

1990-1992, Member, University Council, Chiang Mai University

1992-1994, by the election

1994-1996,

1996 -1998.

1997 - 1998 Founding Member of the Examination and Certifying Board in Dental Public Health, the Dental Council of Thailand

1985 1988, Chairman, Department of Community Dentistry

1992 - 1998 Faculty of Dentistry, Chiang Mai University.

1993 - 2001 Director, the Study and Development Center of Dental

Public Health, Faculty of Dentistry, Chiang Mai University.

1990 - 1992 Associate Dean for the Administration Affairs,

Graduate School, Chiang Mai University

1986-1988 On-site Coordinator, International Dental Public Health

Program, Sparkman Center for International Public Health

Education Program (SCIPHE) University of Alabama at

Birmingham at Faculty of Dentistry, Chiang Mai University

1984 - 1985 Associate Dean for the Research and Development Affairs,

Faculty of Dentistry, Chiang Mai University

1982 - 1983 Assistant Dean for Academic affairs, Faculty of Dentistry,


1978 - 1982 Founder and Head, the Project of Community Dentistry

Department, Faculty of Dentistry, Chiang Mai University

1974 - 1976 Instructor, Department of Oral Surgery, Faculty of Dentistry,

Chiang Mai University.

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6. Teaching Experience (please list the subject and total number of credits or hours of teaching)

Faculty of Dentistry, Chiang Mai University

1) Lecturer in Introduction to Oral Surgery ( 1974-1976) 6 hrs

2) Instructor in Oral Surgery clinic ( 1974-1976) 15 hr

3) Mentor & lecturer in Introduction to Community Dentistry;

3rd year dental students (1978-1990) 16 hrs

4) Lecturer in Dental Public Health; 5th year dental students (1978-1988) 8 hrs

5) Lecturer and instructor in Preventive Dentistry;

6th year dental students (1978-1988, 1990-1998) 6 hrs

6) Lecturer in Dental Practiced Management;

6th year dental students (1978-1988, 1990-1998) 9 hrs

Faculty of Nursing, Chiang Mai University

Lecturer, Oral Disease; Screening and Prevention; 3rd year nursing students

(1981-1984) 6 hrs

Faculty of Medicine, Chiang Mai University

Lecturer, Dental Public Health Administration; 6th year medical

students (1981-1984) 6 hrs

Graduate School, Chiang Mai University

Course Director, Master of Public Health program; Epidemiology (1993-1997) 12 hrs

7. Publication of Research, Articles, Textbooks and/ or Other Educational

And / or Academic Works (please enclose relevant sample pages, if any)

1) Author: Bureekul T., Chaiyasomtop T., Kanchanakamol U., Sangpetch S.

Title: A PAR Study of Social Capital for Sustainable Community Development: A case study for sustainable development in the

Communities near the electricity generating power plant at

Nua-Klong District, Krabi Province Southern Thailand,

12

Publisher or Journal: King Prachathipok Institute IBSN: 978-974-449-613-3 Year of Publication: 2011

Pages Numbers: 62

2) Author: .

Title:

(Peoples Audit) 2 4

(UNDP)

Publisher or Journal: .

ISBN: 978-974-449-412-2

Year of Publication: 2552

Pages Numbers: 16

3) Author: .

Title:

(Peoples Audit) 3 11

(UNDP)


ISBN: 978-974-449-413-9


Pages Numbers: 21

13

4) Author:

Title: :


(UNDP)


ISBN: 978-974-449-413-9


Pages Numbers: 18

5) Author: .

Title: : .


(UNDP)

Publisher or Journal: . .

ISBN: 978-974-449-413-9


Pages Numbers: 8

6) Author:

Title:

(Peoples Audit)

4 15

(UNDP)

14


ISBN: 978-974-449-414-6

Year of Publication: 2552.

Pages Numbers: 15

7) Author:

Title:

(Peoples Audit)

7 23

(UNDP)


ISBN: 978-974-449-417-7


Pages Numbers: 39

8) Author: .

Title:

5

(UNDP)


ISBN: 978-974-449-361-3


Pages Numbers: 39

15

9) Author:

Title:

3.2

(UNDP)


ISBN: 978-974-449-361-4


Pages Numbers: 19

10) Author:

Title:

8 , :

.


ISBN 974-657-264-4


Pages Numbers: 29

11) Author:

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,

Title: ,

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16

ISBN 974-657-264-4


Pages Numbers: 106

12) Author:

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Title:

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ISBN 974-657-263-6


Pages Numbers: 106

13) Author: . :

Title: :

,

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ISBN 974-656-035-3


Pages Numbers: 44

17

14) Author:

Title: :

10

Publisher or Journal:


Pages Numbers: 33

15) Author: .

Title: .

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:

.


ISBN 974-565-502-3


Pages Numbers: 17

.

16) Author: Tuongratanaphan, S., Kanchanakamol U

Title: Comprehensive Dental Care Concept. Publisher or Journal: Chiang Mai. Dent. J. Vol. 21 number 2, Year of Publication: 2000

Pages Numbers: 17

18

17) Author: Puangpinyo W., Kanchanakamol U

Title: Situation of Dental Fluorosis in Community of Ban Sankayom, Tambon Makuaghae, Amphoe Muang, Changwat Lamphun.

Publisher or Journal: Chiang Mai. Dent. J. Vol. 19 Special Issue 49 -59, Year of Publication: 1998

Pages Numbers: 10

18) Author: Kanchanakamol U.

Title: People Participation in Community Oral Health Promotion Program. Publisher or Journal: Chiang Mai. Dent. J .Vol. 19 Special Issue 6 10


Pages Numbers: 5

19) Author: Kanchanakamol U., Tuongratanaphan S., Tuongratanaphan

S., Chittaisong, C., Pattanaporn, K., Lertpoonvilaikul, W., Navia JM. Davies GN.

Title: Prevalence of Developmental Enamel Defects and Dental

Caries in Rural Preschool Thai Children

Publisher or Journal: Community Dental Health [1996, 13(4):204-207

Cited by: Malnutrition and dental caries: a review of the literature.

(PMID:16251787)

Psoter WJ, Reid BC, Katz RV.

Caries Res. [2005]

Interpreting sex differences in enamel hypoplasia in human and non-

human primates: Developmental, environmental, and cultural

considerations.

(PMID:10601984)

Guatelli-Steinberg D, Lukacs JR.

Am. J. Phys. Anthropol. [1999]

Health of infants in an Imperial Roman skeletal sample: perspective from

dental microstructure.

19

(PMID:16365859)

FitzGerald C, Saunders S, Bondioli L, Macchiarelli R.

Am. J. Phys. Anthropol. [2006]

The relationship of enamel defects and caries: a cohort study.

(PMID:21114593)

Targino AG, Rosenblatt A, Oliveira AF, Chaves AM, Santos VE.

Oral Dis [2011]

Association between enamel hypoplasia and dental caries in primary

second molars: a cohort study.

(PMID:19648745)

Hong L, Levy SM, Warren JJ, Broffitt B.

Caries Res. [2009]

Interproximal contact hypoplasia in primary teeth: A new enamel defect

with anthropological and clinical relevance.

(PMID:11533988)

Lukacs JR.

Am. J. Hum. Biol. [1999]

Prevalence of demarcated hypomineralisation defects in second primary

molars in Iraqi children.

(PMID:22276809)

Ghanim A, Manton D, Marino R, Morgan M, Bailey D.

Int J Paediatr Dent [2013]

Enamel hypoplasia in the primary dentition of monozygotic and dizygotic

twins compared with singleton controls.

(PMID:20961345)

Taji SS, Seow WK, Townsend GC, Holcombe T.


Relationship between Untreated Dental Caries and Weight and Height of

6- to 12-Year-Old Primary School Children in Bangladesh.

(PMID:23690777)

Mishu MP, Hobdell M, Khan MH, Hubbard RM, Sabbah W.

Int J Dent [2013]

Association between developmental defects of enamel and early

childhood caries: a cross-sectional study.

20

(PMID:24650107)

Correa-Faria P, Paixao-Goncalves S, Paiva SM, Pordeus IA, Marques LS,

Ramos-Jorge ML.



Pages Numbers: 4


Title: Concept in Oral Hygiene Practice Publisher or Journal: Chiang Mai. Dent. J .Vol. 16 Number1: 15-22


Pages Numbers: 8

21) Author: Kanchanakamol U., Umpriwan, R., Chotikastira, N.,

Srisilapanan, P., T-Ratanapan, S.N., Cholitkul, W. and

Chat-U-Thai, T.:

Title: Effect of a Dentifrice Containing Triclosan and

Copolymer on Plaque Formation and Gingivitis

Publisher or Journal: Journal of Periodontology [1995, 66(2):109-112]

http://www.joponline.org/doi/abs/10.1902/jop.1995.66.2.109

Cited by:

A systematic review of the effectiveness of self-performed

mechanical plaque removal in adults with gingivitis using a manual

toothbrush.

(PMID:16128840)

van der Weijden GA, Hioe KP.

J. Clin. Periodontol. [2005]

The effectiveness of a toothpaste containing triclosan and

polyvinyl-methyl ether maleic acid copolymer in improving plaque

control and gingival health: a systematic review.

21

(PMID:15560802)

Davies RM, Ellwood RP, Davies GM.

J. Clin. Periodontol. [2004]

Oral hygiene in the prevention of periodontal diseases: the

evidence.

(PMID:21134231)

van der Weijden F, Slot DE.

Periodontol. 2000 [2011]

Randomized controlled clinical trials on agents used for chemical

plaque control.

(PMID:16451305)

Paraskevas S.

Int J Dent Hyg [2005]

Metal salts, essential oils and phenols--old or new?

(PMID:9643234)

Jackson RJ.


The effectiveness of self-performed mechanical plaque control

with triclosan containing dentifrices.

(PMID:16451308)

Hioe KP, van der Weijden GA.

Int J Dent Hyg [2005]

Is there a role for triclosan/copolymer toothpaste in the

management of periodontal disease?

(PMID:19662054)

Blinkhorn A, Bartold PM, Cullinan MP, Madden TE, Marshall RI,

Raphael SL, Seymour GJ.

Br Dent J [2009]

Toothpaste in the control of plaque/gingivitis and periodontitis.

(PMID:18715353)

Davies RM.



Pages Numbers: 4

22


Title: The effectiveness of the meditation tooth brushing

Method using Concept 45o Toothbrush for removal

of dental plaque.

Publisher or Journal: Chiang Mai University (R E8882)

http://search.lib.cmu.ac.th/search/t?SEARCH=The+Effectiveness++of+the+meditation

+toothbrushing+method+using+&SUBMIT=Search

NRCD Research Bibliography and Thesis 2009, No. 37-15 www.riclib.nrct.go.th/download521/homepage.htm

http://books.google.co.th/books?id=tcceQwAACAAJ&hl=th


Pages Numbers: 42

23) Author: Kanchanakamol U., Srisilpanan, P., Umpriwan, R., and

Kongmalai A.

Title: The Effectiveness of the Concept 45o Toothbrush on

Removal of Dental Plaque in Adults.

Publisher or Journal: International Dental Journal [1993, 43(2):116-120]

http://europepmc.org/abstract/MED/8320004

Cited By: Antimicrobial effects of mechanical debridement.

(PMID:12013348)

Petersilka GJ, Ehmke B, Flemmig TF.


Preventive strategies and supportive treatment.

23

(PMID: 11155182)

Hancock EB, Newell DH.



Pages Numbers: 5

24) Author: Kantamaraturapot, K., and Kanchanakamol, U

Title: The Effectiveness of Oral Hygiene Program in Primary

School children under Supervision of Teachers and

Schoolchild Health Volunteers.

Publisher or Journal: J. Dent. Assoc. Thai, 42: 5-6: 269-278.


Pages Numbers: 10

25) Author: Kanchanakamol U., Srisilapanan, P.

Title: The Effectiveness of the Newly Designed

Concept 45oToothbrush for Removal of Dental

Plaque in Primary Schoolchildren.

Publisher or Journal: International Dental Journal [1992, 42(2):78-82]

Cited by: Antimicrobial effects of mechanical debridement.

(PMID:12013348)

Petersilka GJ, Ehmke B, Flemmig TF.



Pages Numbers: 5

26) Author: Srisilapanan, P., Kanchanakamol, U

Title: Attitude of Mandatory Public Services Dentists on

their Employments.

24

Publisher or Journal: Chiang Mai. Dent. J., 12: 1, 25-32,


Pages Numbers: 8

27) Author: Chat-U-Thai, T. and Kanchanakamol, U.

Title: The Low G.P.A. of Chiang Mai University Dental

Graduates: Fact & Problems

Publisher or Journal: Journal of Dental Research (JDR)

Abstract, 70:4,862


Pages Numbers: 1

28) Author: Kanchanakamol, U., and Pattanaporn, K.

Title: The Behavior of Utilizing Household Defluoridators in

the Areas of High Fluoride Content in Drinking Water


Abstract, 70: 4, 858


Pages Numbers: 1

29) Author: Maki, Y., Takaesu, Y. , Chittaisong, C.,

Kanchanakamol, U., Dusadeepan, A

Title: Oral Health Survey of Hill tribes and Urban People in

Chiang Mai, Thailand

Publisher or Journal: The Shikawa Gakuho 90: 891


25

Pages Numbers: 1

30) Author: Chandramangkorn, M. and Kanchanakamol, U.

Title: The Clinical Comparison of 2 Kinds of Composite

Labial Veneer in a Treatment of Dental Fluorosis.


Abstract, 69: 4, 1096,


Pages Numbers: 1

8. Foreign Language Proficiency

Language Level of Proficiency (excellent, good, or fair)

Listening Speaking Reading Writing

English excellent excellent excellent excellent

Tai-Lue good good fair fair

9. Honors and/ or Awards

Title Awarding Institution or Organization

Year

Role Model, Social Change Leader in Health Promotion and Environment.

Health Department,

Ministry of Health

2012

Fulbright Fellow, Fulbright New Century Scholar Program 2001 Challenges of Health in a Borderless World.

The U.S Department of State, USA.

2001

Patent on Concept 45o Toothbrush, The invention has been patented in 1989

Department of Commercial Registration, Ministry of Commerce

1989

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10. ACDEMIC PRESENTATIONS

1) Presenter: Kanchanakamol U.

Title: Learning Social Advocacy through Participatory Action Study in Oral Health Promotion.

Paper Presentation: The Third Congress of the Asian Academy of Preventive Dentistry

(AAPD)

Venue: Chiang Rai, Thailand

Year of Presentation: November 2-4, 1998

2) Presenter: Vaseenon T., Inpra W., Jiwong J., Obsuwan K., Kanchanakamol U. :

Title: The Use of Participatory Action Approach to Develop Community Oral Health Promotion


(AAPD)

Venue: Chiang Rai, Thailand,


3) Presenters: Korwanit N., Kaewmakam S.,Wongkom A.,Obsuwan K., Kanchanakamol, U.

Title: Participatory Action Study to Develop Community Preventive Program in Chiang Khong District, Chiang Rai


(AAPD)


Year of Presentation: November 2-4, 1998.

27

4) Presenter: Kanchanakamol, U.

Title: CMU Community Dentistry Curriculum Development; The project

description and 3- years experience.

Paper Presentation: the International Meeting to Commemorate the 18th Anniversary of

the Dental Faculty, Khon Kaen University

Venue: Khon Kaen, Thailand

Year of Presentation: March 26-28, 1997.

5) Presenter: Kanchanakamol, U., Srisilapanan, P., Korwanit, N., Khongsanongtham, S.

Title: The Effects of a Plaque Control Program Learning through Teaching

On Dental Students Dental Plaque Accumulations and Gingival

Condition

Paper Presentation: The 4 th World Dental Congress on Preventive Dentistry (WDCP)

Venue: Umea, Sweden

Year of Presentation: September 2-5, 1993.

6) Presenter: Kanchanakamol, U., Umpriwan, R., Chotikastira, N., Srisilapanan, P.,

T-Ratanapan, S.N., Cholitkul, W., Chat-U-Thai, T.

Title: Effect of a Dentifrice Containing Triclosan and Copolymer on Plaque

Formation and Gingivitis.

Paper Presentation: The 1st Annual Meeting of Thai Dental Research (TDR)


Year of Presentation: October 12-13, 1992.

28

7) Presenter: Kanchanakamol, U., Chittaisong, C., Pattanaporn, K., Lertpoonvilaikul, W.,

T- Ratanapan, S.N., T-Ratanapan, S.V, Davies, G.N., and Navia, J.M.

Title: Prevalence of Enamel Hypoplasia and Dental Caries in Vegetarian

Karen Children aged 1-4 years at Phra Bath Huey Tom, Lumphun

Thailand.

Paper Presentation: The 7th Scientific Meeting of the International Association of Dental

Research South East Asian Division (IADR/SEA)

Venue: University of Hong Kong, Hong Kong


8) Presenter: Kantamaraturapot, K and Kanchanakamol, U.

Title: The Effectiveness of Oral Hygiene Program in Primary Schoolchildren under

Supervision of Teachers and Schoolchild Health Volunteers.



Venue: University of Hong Kong, Hong Kong


9) Presenter: Srisilapanan, P., Kanchanakamol, U.

Title: Attitude of Mandatory Public Services Dentists on their Employments



Venue: University of Hong Kong, Hong Kong,


29

10) Presenter: Kanchanakamol, U., and Srisilapanan, P.

Title: The Effectiveness of the Newly Designed Concept 45o Toothbrush for

Removal of Dental Plaque in Primary Schoolchildren

Paper Presentation: The 87th Annual World Dental Congress, Federation Dental

International (FDI)

Venue: Singapore

Year of Presentation: September 10 -14, 1990.

11) Presenter: Chat-U-Thai, T. and Kanchanakamol, U.

Title: The Low G.P.A. of Chiang Mai University Dental Graduates: Fact &

Problem.



Venue: University of Singapore, Singapore

Year of Presentation: September 8-9, 1990

12) Presenter: Kanchanakamol, U., and Pattanaporn, K.

Title: The Behavior of Utilizing Household Defluoridators in the Areas of High

Fluoride Content in Drinking Water.



Venue: University of Singapore, Singapore


30

13) Presenter: Kanchanakamol, U., Srisilpanan, P. , Umpriwan, R. , and Kongmalai A. :

Title: The Effectiveness of the Concept 45o Toothbrush on Removal of

Dental Plaque in Adults



Venue: Pattaya, Thailand


14) Presenter: Chandramangkorn, M. and Kanchanakamol, U.

Title: The Clinical Comparison of 2 Kinds of Composite Labial Veneer in a

Treatment of Dental Fluorosis



Venue: Pattaya, Thailand


15) Presenter: Kanchanakamol, U., Srisilapanan, P., and Chittaisong, C.

Title: Reliability of the Dental Disease Surveillance Indices.

Paper Presentation: The Annual Meeting of Thai Dental Association

Venue: Bangkok, Thailand

Year of Presentation: December 11-13, 1986.

16) Presenter: Kanchanakamol, U., Dusadeepan, A., Kongmalai, A., and Kongmalai, J.

Title: The Efficiency of two kinds of Chewing Sticks in Oral Hygiene Programs among the

Rural Thai Primary Schoolchildren

Paper Presentation: The Annual Meeting of Thai Dental Association


31

Year of Presentation: November, 27-30, 1979

11. SPEECHES & OTHER SIGNIFICANT CONFERENCE INVOLVEMENT:


Title: Research Topic in Oral Health in the Next Decade. Place of Presentation: The Thailand Research Fund (TRF) Conference on The Priority Setting of Research Topics in Oral Health Organizer: The Faculty of Dentistry Mahidol University Venue: The Chau Phraya Park Hotel, Bangkok, Year of Presentation: November 27-28, 1996

2) Presenter: Kanchanakamol U.:

Title: NGOs and the Conflictive Participation in the Government Development Projects. Place of Presentation: The Annual Meeting of the Northern Region Center for the Internal Security Protection Organizer: The 236Unit, Naresuan Barrack, Pitsanulok Venue: The Fourth Army Department, Mae-Sod District, Tak Province Year of Presentation: November 21, 1996.

3) Panel Presenters: Eawsriwong N., Wattanachai K. , Kanchanakamol U.:

Title: Chiang Mai University Vision 2020

Place of Presentation: The Project Forum Discussion on Artistic, Philosophical, and

Scientific Problems

Organizer: The Faculty of Fine Art, Chiang Mai University,

Venue: Grand conference room, Chiang Mai University, Chiang Mai, Thailand

Year of Presentation: November 8, 1996.

32


Title: The Case Study of the Impact of the Government Development

Projects on Local People

Place of Presentation: The Seminar on the People Participation Administration at the

Interior Ministry Meeting Room

Organizer: The Dhamrong Rajanupap Institute, Bangkok

Venue: Bangkok. Thailand

Year of Presentation: October 29, 1996.

5) Panel Presenters: Sacrig R., Kanchanakamol U., Naruemitr-rekakarn S.

Title: Green Politics.

Place of Presentation: The Project Forum Discussion on Artistic, Philosophical,

and Scientific Problems

Organizer: The Faculty of Fine Art, Chiang Mai University

Venue: Chiang Mai, Thailand

Year of Presentation: August 14, 1996.


Title: The People Participation in the Community Environment Management and the

Green Areas in Chiang Mai Province

Place of Presentation: The Public Hearing on the Planning of the Community

Environment Management and the Green Areas in Chiang Mai Province

Organizer: Social Research Institute, Chiang Mai University, Chiang Mai, Thailand

Venue: Chiang Mai, Thailand

Year of Presentation: June 21, 1996.

33

7) Panel Presenters: Boonmee, T., Kemchalerm W., Kanchanakamol, U. :

Title: The Civil Society in Dental Public Health; New Alternative strategy in solving Oral Health Problems Place of Presentation: The Annual Meeting of the Dental Public Health Society Organizer: The Dental Association of Thailand Venue: Maruay Hotel, Bangkok, Thailand Year of Presentation: June 25, 1996.

8) Presenter: Kanchanakamol, U.:

Title: The Northern Industrial Estate in Lamphun Province, Thailand: The

Impact on People Quality of Life, Health and Environment

Place of Presentation: The Academic Meeting of Thai NGOs on the Government Policy

in Promotion of Industries to the Regions of Thailand,

Organizer: Faculty of Economics, Chulalongkorn University, Bangkok, Thailand

Venue: Faculty of Economics, Chulalongkorn University, Bangkok, Thailand

Year of Presentation: June 17, 1996.


Title: The Vision of Thailand Environment. Place of Presentation: The Regional Seminar in the World Environment Day, Organizer: The Department of Environment Quality Promotion and the Waing Ping Citizens Council

Venue: P. S. K. Hotel, Chiang Mai, Thailand

Year of Presentation: June 7, 1996


Title: The Pollution of the Northern Industrial Estate in Lamphun Province,

Thailand

Place of Presentation: The 15th General Meeting of Japan Environmental Council (JEC)

Organizer: Faculty of Medicine, Kumamoto University, Kumamoto, Japan.

34

Venue: Conference room, Faculty of Medicine, Kumamoto University, Kumamoto, Japan.

Year of Presentation: March 28, April 1, 1996.


Title: The Desired Vision for Health for All in Thailand.

Place of Presentation: The 8th General Meeting of the Occupational Medicine and

Environment Association

Organizer: The Occupational Medicine and Environment Association

Venue: Siam City Hotel, Bangkok, Thailand

Year of Presentation: February 7-8, 1996

12) Presenter: Kanchanakamol, U. Title: The Vision of Graduates in Globalization. Place of Presentation: The Orientation Meeting of the final year students of Payup University Organizer: Payup University. Venue: Payup University, Chiang Mai, Thailand Year of Presentation: January 27, 1996,


Title: The Vision of School Teachers in Globalization.

Place of Presentation: The primary School teachers meeting in the Teachers Day.

Organizer: Local Teacher Society

Venue: Lee district, Lamphun, Thailand

Year of Presentation: January 1, 1996.

14) Presenter: Kanchanakamol, U. :

Title: Chiang Mai Environmental Problems and the Future of Country

Development Direction

35

Place of Presentation: The Seminar on the Youth and the Urban Environmental

Development

Organizer: The Center for Environmental Education, Educational Region 8

Venue: YMCA, Chiang Mai, Thailand

Year of Presentation: October 17, 1995


Title: The Vision in Country Development for Quality of Life and Health of

Thai People: The Urgent Need in Solving Environmental Crisis

Place of Presentation: The 7th General Meeting of the Occupational Medicine

and Environment Association

Organizer: The Occupational Medicine and Environment Association


Year of Presentation: January 17-18, 1995

16) Panel Presenters: Tantiwipawin W., Kanchanakamol, U., Chat-U-Thai, T., Juengpanit S.,

Jitjumnong P. and Tianpisan R

Title: Thai Dental Education in the Next Decade.

Place of Presentation: The Scientific Meeting of the Executive Members of the Dental

Schools of Thailand, entitled Thai Dentistry in the Next Decade

Organizer: Executive Members of the Dental Schools of Thailand

Venue: Prince of Songkhla University, Songkhla

Year of Presentation: August 29-31, 1990


Title: The Philosophy and Concepts in Preventive Dentistry.

36

Place of Presentation: The National Symposium on the Clinical Preventive Dentistry

Organizer: The Faculty of Dentistry, Chiang Mai University

Venue: The Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand

Year of Presentation: October 8-10, 1990.

18 Presenter: Kanchanakamol, U. :

Title: The Principle of Preventive Dentistry

Place of Presentation: The Scientific Meeting of the 10th Anniversary of the Faculty

of Dentistry, Khonkean University, Khonkean, Thailand,

Organizer: The Faculty of Dentistry, Khonkean University

Venue: The Faculty of Dentistry, Khonkean University, Khonkean, Thailand,

Year of Presentation: December 19-2, 1990

19) Panel Presenter: Kanchanakamol, U., Lekfuengfu S., Songpaisan U., Phantumvanit P.

Title: Prospects of Preventive Dentistry in Thailand.

Place of Presentation: The Annual Scientific Meeting of the dental Association of

Thailand, Chiang Mai University, Chiang Mai, Thailand,

Organizer: The Faculty of Dentistry, Chiang Mai University

Venue: Chiang Mai University, Chiang Mai, Thailand

Year of Presentation: March 27-29, 1984.

20) Presenter: Kanchanakamol, U. :

Title: Fluorides in the Environment in Thailand. Place of Presentation: The National Seminar on How Fluorides Prevent Tooth Decay Organizer: The Faculty of Dentistry, Mahidol University

Venue: The Faculty of Dentistry, Mahidol University

37



Title: The Future of Dental Personnel in Thailand.

Place of Presentation: The Scientific Annual Meeting of the Dental Association of

Thailand

Organizer: The Dental Association of Thailand


Year of Presentation: December, 8-10, 1983.


Title: The Traditional Oral Hygiene Device for the Rural Thais.

Place of Presentation: The 6th Annual Research Meeting, Mahidols Day

Organizer: The Faculty of Medicine, Chiang Mai University

Venue: The Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

Year of Presentation: September 24, 1982.


Title: Fluorides, Chlohexidines and Tooth brushing in Oral Health Practice.

Place of Presentation: Scientific Annual Meeting of the Dental Association of Thailand,

Venue: Bangkok, Thailand,

Organizer: The Dental Association of Thailand


38


Title: The Role of Paramedical Personnel, Wechakorn in Dental Health

Services.

Place of Presentation: The 5th Annual Meeting of Lampang Health Development Project,

Ministry of Public Health,

Venue: Chiang Mai, Thailand,

Organizer: Health Department, Ministry of Public Health,

Year of Presentation: September, 5-8, 1980.

12. ORGANIZING OF SEMINAR/WORKSHOP/SYMPOSIUM

Conference Organizer and Lecturer :

National Conference on Holistic Approach in Oral Health Care, Held at the

Control Plaza Hotel, Bangkok, December 7, 1993.

Symposium Organizer and Lecturer

National Symposium of Clinical Preventive Dentistry in Thailand, held at

Chiang Mai University, October 8-10, 1990.

Course Director and Lecturer :

Training the Paramedical Personnel Wechakorn in Dental Public

Health, Lampang Health Development Project, Department of Health,

Ministry of Public Health May 12-June 17, 1987.

Course Organizer and Lecturer:

Continuing Education Teaching ;

1) Intercountry Center for Oral Health, Ministry of Public Health, Chiang Mai , The 1st Course in Dental Public Health, Community Diagnosis; Dental Health

Behavior Survey (KAP Survey), Collection and analysis of data, August 9-

12, 1992.

39

2) Intercountry Center for Oral Health, Ministry of Public Health, Chiang Mai , Research Methodology in Dental Public Health : Health Service Research, May 2- 13, 1983.

3) Intercountry Center for Oral Health, Ministry of Public Health, Chiang Mai , Dental Public Health Community Diagnosis; Dental Health Behavior Survey,

Analysis of data July 3-20, 1983

4) Intercountry Center for Oral Health, Ministry of Public Health , Chiang Mai ,

Dental Public Health , Community diagnosis; Dental Health Behavior

Survey, analysis of data July 3-20, 1984.

5) Intercountry Center for Oral Health, Ministry of Public Health, Chiang Mai:

Human Performance Logics in Dentistry; August 3-12, 1990.

6) Lampang Provincial Public Health Office, Ministry of Public Health , Lampang: Pit & Fissure Sealants in Dental Public Health, December 25, 1992.

7) The 1st Regional Dental Public Health Center, The Fundamental Research Methodology for Dental Personnel for Dental Personnel : Research Design in Dental Public Health , at U-Thong-In Hotel, Ayudthaya,

June 22-26, 1992.

8) The 10th Regional Dental Public Health Center, The Fundamental Research Methodology for School Dental Nurses : Research Design in Dental

Public Health, at Lanna Hotel, Chiang Mai , July 16-22,1993.

9) The 1st Regional Dental Public Health Center, Reporting and Presentation Research : How to Criticize Scientific Papers, at Silver Sand Hotel,

Pattaya, Cholburi, February 11-15, 1993.

10) Intercountry Center for Oral Health, Ministry of Public Health, Chiang Mai ,

Dental Public Health for School Dental Nurses: Philosophy and Principle of

Preventive Dentistry, Chiang Mai , July 21-30, 1993.

11) Khon Khan University, Faculty of Nursing: Training of Trainers: How to be the

Effective Modulator in the Meeting: Khon Khan, May 16-17, 1991.

40

13. SPECIAL MERIT

Consultant, Chiang Mai Municipality Development Committee (1999-2001)

Director, the Northern Coordinating Center of the People Organizations

(NCCPO) Chiang Mai (1998 -2002)

Consultant, Assembly of the Poor, Thailand (1997-2003)

Consultant, Campaign Committee for Popular Democracy (CCPD), Bangkok

(1998- 2005) Chairman, Campaign Committee for Local Autonomy (CCLA),

Social Research Institute, Chiang Mai University (1993-1997)

Vice Chairman, Wiang Ping Citizen Council, Chiang Mai Province (1997-1998)

Secretary ,Wiang Ping Citizen Council, Chiang Mai Province (1996-1997)

Advisor to the Chiang Mai Province Governor, Ad hoc Committee for Preserving

Ping River and Environment, (1993-present).

Chairman, Coordinating Committee for Conserving Ping River and

Environment (CPEC), Chiang Mai (1993-1996)

Chairman, the Executive Committee for the Poll Watch: The Election

of the Member of the Organization of Administration of the

Subdistrict in Chiang Mai Province (1995).

Member , Ad hoc Committee for the Public Relation and Public Hearing,

for Establishing Political Reform, The Office of the Secretary General

of the Prime Minister.(1995)

Member, Campaign Committee for Political Reform, Chiang Mai province

The Office of the Secretary General of the Prime Minister

(1997- 1999)

Member, Provincial Executive Committee for Conserving Environment, Lamphun

province (1993- 1997)

Member, the Executive Committee of the Science Association of Thailand Northern

Region Branch (1985-1986, 1993-1994)

Member, the Executive Committee: Buddhist Association of Thailand;

Chiang Mai. (1991-1995)

41

Member, the Chiang Mai Toastmaster Club, Chiang Mai (1981-present)

Member, the Dental Association of Thailand (1994-present)

Member, the Princess Mothers Medical Volunteer Foundation

(1973- 1995)

Chairman, Coordinating Committee for Democracy Development

Chiang Mai (1991-1992)

Member, the Executive Committee for the Poll Watch, Upper Northern

Region (1990, 1992)

President, Chiang Mai Toastmaster Club, Chiang Mai (1984-1985)

14. Areas of Academic Expertise

Community Dentistry


Preventive Dentistry

Health Promotion

Public Participation

Community Development

Community Empowerment

15. Areas of academic and/or Community Service Interest

Community Development

Community Participation

Community Empowerment

Health Promotion

Environmental Conservation

Cultural Conservation

16. Hobbies and/or Areas of Special Interest

Public Speaking,

Reading, Writing Poem

Table Tennis,

Singing,

42

17. Professional Development Plans and Goals

My Professional Development Plans are to become a full time staff and engage in teaching, mentoring, research, academic service to society and collaborate with the dental school staff, hospitals and affiliated institutes rendering the new dental school plans.

My goals are to become a professional role model as an academic mentor and teacher inspiring dental students to fulfill the Dental school and Mae Fah Luang Universitys commitments as the volunteerism, knowledgeable dentists who have a moral response to the social aspirations of His Royal Highness the Princess Mother to all the people having a way of promoting good dental health

The other goals that I shall strive hard to achieve are to become an expert in Participatory Action Research, Social Innovation, Social Change Leadership, and Community Mentorship which they are my main interest.

18. Areas of Research Interest Likely Contributing to the Development of Mae Fah Luang University and/ or the Country (Thailand) I believe that Solving Problems through Appreciative Inquiry is better than through Problem-Solving thus:

Appreciative Inquiry requires a skill building orientation in the process of organizational transformation and leadership. Solving problems is not achieved by problem-solving but by adding essential skill sets.

Appreciative Inquiry focuses on developing new change processes where there will be high value added. The focus is on adding value rather than subtracting problems. (Note: there will always more problems to subtract if problem-solving is the leaders focus.)

Appreciative Inquiry establishes truth by systemic consultation; that is, leading and listening along the channels of the hierarchy and not stopping at the front / top of the hierarchy.

Appreciative Inquiry builds consultancy groups or learning partnerships in areas of competency and responsibility. Solving problems with the end in mind is best achieved by those who know the end in mind.

Therefore, areas of Research Interest Likely Contributing to the Development of Mae Fah Luang University and/ or the Country I prefer are:

1) Participatory Action Research Study of learning and teaching experience in dental students through appreciative Inquiry: A case study for developing teaching and learning atmosphere to inspire dental students toward successful professionalism, liberation, and happiness.

2) Participatory Action Research Study of learning and teaching experience in dental students through wisdom Based Learning: A case study for empowering dental students toward positive approach, good morality and spirit.

43

3) Participatory Action Research Study of Empowering at-risk students through appreciative inquiry: A qualitative case study design to facilitate the first two stages of an appreciative inquiry (AI) 4-D cycle discovery and dream.

4) Participatory Action Research Study on Dental Health Promotion in Preschool and Primary School Children in Chiang Rai Province

5) Participatory Action Research Study of Social Capital for Sustainable Community Development: A case study for sustainable development in the tribal communities at Chiang Rai province Northern Thailand.

6) Participatory Action Research Study on Community Empowerment and Participatory Community Resource Management: A case study of Community Capacity Building for sustaining community development in tribal villages, Chiang Rai province.

7) Participatory Action Research Study on Community Empowerment and Participatory Community Resource Management: A case study of Community Capacity Building in tribal communities for crisis haze from forest fire management in Chiang Rai province.

8) Participatory Action Research Study on Community Empowerment and Participatory Community Health Promotion: A case study of Community Capacity Building in disabled communities for their quality of life in Chiang Rai province.

9) Participatory Action Research Study on Community Empowerment and Participatory Community Health Promotion: A case study of Community Capacity Building in marginalized communities for their enduring social changes in Chiang Rai province.

10) Participatory Action Research Study on Community Empowerment and Participatory Community Health Promotion: A case study of Community Capacity Building in elderly communities for their enduring social changes in Chiang Rai province.

19. Courses or Programs that the Applicant is Qualified and willing to teach or Assist

19.1 Major Courses:

1. Health Promotion

2. Prevention Dentistry,

3. Community Dentistry,

4. Dental Public Health

5. Ethic and Dental Professional Development,

6. Dental Student Quality Development.

19.2 Related Courses:

1. Public Speaking (PS)

2. Community Empowerment (CE)

3. Asset-Based Community Development (ABCD)

4. Appreciative Inquiry (AI)

44

5. Participatory Action Research (PAR)

6. Public Participation (PP)

7. Pluralistic Democracy

8. Technology of Participation (TOP)

9. Diffusion of Innovation (DOI), Adoption to Innovation (ATI)

10. Participatory Action Planning (PAP)

11. Participatory Evaluation on Empowerment (PEE)

12. Positive Community Approach

13. Walking Mapping

14. Cultural Community Development

15. Strength-Based Community Development

15. Performance Logic in Dentistry

16. Wisdom- Based Learning

17. References

17.1 Advisor, Supervisor or Superior

Name: Assoc. Prof. Thanong Chat-Uthai

Position: Dean, Dental School

Contact Address Mae Fah Luang University

333 Moo 1, Thasud Subdistrict,

Muang District, Chiang Rai 57100, Thailand Telephone: (053) 916020; Email address: [email protected]

17.2 Classmate or Colleague

Name: Assoc. Prof. Wirach Pattanaporn

Position: Former Dean, Dental School, Chiang Mai University

Contact Address: Faculty of Dentistry


Sutep Road

Chiang Mai, 50200

Thailand

Telephone: 081-671 5125 Email address: [email protected]

45

17.3 Subordinate (if any)

Name: Asst. Prof. Dr. Songwut T-Rattanaphan

Position: Lecturer

Contact Address: Community and family Dentistry Department



Sutep Road

Chiang Mai, 50200

Thailand

Telephone: 0818844366; Email address: [email protected]

18 If you are appointed, how soon will you be able to take up the position at Mae Fah

Luang University?

I am already available.

19. Where and how did you learn about this position? (Please supply details)

I have been appointed at the new Mae Fah Luang dental school as a part time staff

for nearly one year and now I am willing to be a full time staff.

20. Salary Expectation: THB 60,000 per month

21. Do you smoke? Yes No

If yes, how long have you been smoking? -

Do you have a plan to quit smoking? Yes No

Reviewing Check List

1. Have you filled in every relevant or applicable blank? If any blank is not relevant or not applicable, write a dash ().

2. Have you provided clear and precise information?

3. Have you enclosed certified copies the required documents? Put a tick () in front of the items enclosed.

ID card

State enterprise ID card

Civil/ military/ police service ID card

46

Degree Certificates (for both undergraduate and graduate levels)

Academic transcripts (for both undergraduate and graduate levels)

Household registration

Name and/ or surname change certification (if applicable)

Marriage certificate (if married)

Others (please specify):

1. Pension Government Official ID Card,

2. The U.S. Department of State Award Certificate

Fulbright New Century Scholar Program,

3. A copy of Shield of Honor, role model for Leadership Change Health Promotion and Environmental Health,

4. A copy of Patent on Concept 45o Toothbrush,

5. Some cited published research papers

4. The university reserves the right to seek relevant authorities cooperation, at any

future time, to examine, scrutinize and verify all documentary evidence pertaining to this application.

5. Forgery and/ or illegitimate alteration of documents or any part thereof for application- related purpose constitute a criminal offence. The universities reverse the right to reject this application if such acts are proved to have taken place.

I hereby testify that, to the best of my knowledge, the information given herein is true and correct in all respects.

Signature Applicant

(Uthaiwan Kanchanakamol)

Date of Application

15/07/2014

application form aa mae fah luang uthaiwan go

Documents

thai religion

public participation

thai ethnicity

thaiyong religion

health promotion

thailand telephone

buddhist occupation

email address