146459290013

Form PROPE-S2

Page 1 of 9

146459290013

TOTAL SCHOLARSHIP FOR ITB PROFESSIONNAL MASTERS IN

PETROLEUM ENGINEERING

In Collaboration with IFP School (French Institute of Petroleum School)

Total E&P Indonesie will grant a substantial number of scholarships for students from the best
Indonesian Universities with good Technical or Scientific majors in support of the ITB Professional
Masters in Petroleum Engineering.

This program is considered as one of TOTAL E&P Indonesies commitment to develop human resources
in their core business by giving a financial support to outstanding Indonesian students and also further
developing the institutes of higher learning by encouraging international cooperation.

The scholarship candidates should:

Be in their 8th semester or have already graduated in the previous semester,

Have good academic records with GPA min. 3.00,
English proficiency of 500 TOEFL or follow the TOEFL test arranged by ITB and obtain the
passing mark of 500.

Pass the Academic Potency Test conducted by OTO BAPPENAS at ITB with a minimum score of
500.

Total E&P Indonesie will conduct the selection process together with ITB. The grantees will be entitled to
have their tuition fees paid. The fee for the Professional Master PE has been fixed at Rp 39.000.000,
payable Rp 13.000.000,/semester.

A certain number of the successful Scholarship holders will be offered pre-employment agreements with
TOTAL E&P INDONESIE where in addition to the Tuition Fees, a competitive living allowance will be
offered to cover lodging, books and other expenses during the period of the course.

An obligation to work with TOTAL E&P INDONESIE will be required for a period of 2n+1 in which n is the
number of years of the pre-employment agreement between the Scholarship holder and TOTAL E&P
INDONESIE.

This form can be returned before 13 April 2013 to TOTALs local

university correspondent with the address here below
GRAHA KARIR ECC UGM
JL. KRASAK BARAT NO. 20, KOTABARU-YOGYAKARTA
Website: www.ecc.ft.ugm.ac.id
Phone: 0274 - 517728
Page 2 of 9

146459290013

APPLICATION FOR SCHOLARSHIP

PERSONAL DATA
Full Name

Present Address

Permanent Address

Telephone

Email Address

Place & Date of

Birth

Account Number

Bank Address

Photo
3x4 cm

FAMILY DATA
Name

Age

Education

Occupation

Father
Mother
Siblin
g:

1
2
3
4
5

EDUCATION BACKGROUND
School

From - To

Name & Location of School

Elementar
y
Jr. High
Sr. High
University
UNIVERSITY CONTACT NUMBER
University

Faculty/ Major

:
Page 3 of 9

Major Course

Graduated/ Degree
Received

GPA

146459290013
University Address
(with post code)

Telephone & Fax. Number

(with area code)

:
:

ORGANIZATIONAL ACTIVITIES
Name of Organization/ Activities

From - To

TRAINING/ COURSE/ APPRENTICESHIP RECORDS

Kind of Training/ Course/
From - To
Apprenticeship

Position

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 Indonesies Scholarship
Program.

Page 4 of 9

146459290013

Date:

Applicants 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 Banks name, your name and account number).

Page 5 of 9

146459290013

Date : _____________________________
Name : _____________________________

1. Why are you entitled to accept this scholarship?

_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

Page 6 of 9

146459290013

2. Why do you want to continue your study to Master Degree?

_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

Page 7 of 9

146459290013

3. What is your plan after graduated from ITB Professional Masters in Petroleum Engineering?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Page 8 of 9

146459290013
_______________________________________________________________________________________________

Page 9 of 9