APPLICATION FOR SCHOLARSHIP

PERSONAL DATA
Full Name :

Present Address

Permanent Address

Photo 3x4 cm

Telephone E-mail Address Place & Date of Birth Sex

: : : : Male / Female

FAMILY DATA
Name Father Mother Sibling: 1 2 3 4 5 Age Education Occupation

EDUCATION BACKGROUND
School Elementary Jr. High Sr. High University From - To Name & Location of School Major Course Graduated/ Degree Received GPA

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 Indonesies Scholarship Program. 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 TOEFL certificate

Name University Major

WHY I WANT TO CONTINUE MY STUDY IN FRANCE ?

MY PROFESSIONAL PLANS?

WHY TOTAL SHOULD GRANT ME A SCHOLARSHIP?

DESCRIPTION OF HIGHER STUDY