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TOTAL SCHOLARSHIP
Total E&P Indonesie will grant scholarship for 20 students from UI, ITB, UGM, ITS, UPN Veteran
Yogyakarta, STT MIGAS Balikpapan & UNMUL with different majors.
This program is considered as one of our commitment to develop human resources by giving a financial
support to Indonesian outstanding students.
The scholarship candidates should be in 5th
or 7th
semester, have good academic records with GPA min.
3.00, and also good English proficiency.
Total E&P Indonesie will conduct selection process together with the University. The grantees will be
entitled to receive Rp. 4.000.000,-/ semester for one year.
This form can be returned before 16 May 2015 to TOTAL’s local university correspondent with the address here below
For further information, please contact us at : [email protected]
ECC UGM
Universitas Gadjah Mada
Yogyakarta
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APPLICATION FOR SCHOLARSHIP
PERSONAL DATA
Full Name :
Photo 3x4 cm
Present Address :
Permanent Address :
Telephone :
E-mail Address
:
Place & Date of Birth :
Sex : Male / Female
Account Number :
Bank Address :
FAMILY DATA
Name Age Education Occupation
Father
Mother
Sibling: 1
2
3
4
5
EDUCATION BACKGROUND
School From - To Name & Location of School Major Course Graduated/ Degree
Received GPA
Elementary
Jr. High
Sr. High
University
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ORGANIZATIONAL ACTIVITIES
Name of Organization/ Activities From - To Position
TRAINING/ COURSE/ APPRENTICESHIP RECORDS Kind of Training/ Course/
Apprenticeship From - To Organized By Location
ACTIVITIES & HOBBIES
Membership of Professional Association
Hobbies & Sports
Social Activities
ADDITIONAL INFORMATION (if any)
The facts stated in this Scholarship Form are true and complete to the best of my knowledge and belief. I understand and agree to follow all the procedures, regulations, and requirements that related to Total E&P Indonesie’s Scholarship Program. Date: Applicant’s Signature: N.B: Please supply all of this documents, along with this form:
Copy of academic transcripts, from 1st semester until the last semester.
1 photo (3x4 cm).
Copy of the first page of your account book (that stated the Bank’s name, your name and account number).
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Date : _____________________________
Name : _____________________________
1. Why are you entitled to accept this scholarship?
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2. What is your planning after graduated from University?
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