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.
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The scholarship candidates should be in 5 or 7 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 30 May 2015 to TOTALs local university correspondent with the
address here below

Kepala Student Advisory Center

Institut Teknologi 10 November
Kampus ITS Sukolilo, Surabaya

For further information, please contact us at : ep-id-hrc-scholarship@total.com

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APPLICATION FOR SCHOLARSHIP

PERSONAL DATA
Full Name

Present Address

Permanent Address

Telephone

E-mail Address

Place & Date of Birth

Sex

Account Number

Bank Address

Photo
3x4 cm

Male / Female

FAMILY DATA
Name

Age

Education

Occupation

Father
Mother
Sibling:

1
2
3
4
5

EDUCATION BACKGROUND
School

From - To

Name & Location of School

Elementary
Jr. High
Sr. High
University

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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 the first page of your account book (that stated the Banks 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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