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Ref: CSAP.02

Please complete all parts of this form in blue ink or typescript and attach a recent passport photo of yourself. Enclose two (2) additional passport photos, after printing your name and signing on the back of each one. A note at the end of this Form explains who will see the information you supply to us and why. Attach clear copies of documents to be used as attachments to this Application Form. PLACE PHOTOGRAPH HERE

Family name: (as on your I.D.)

Other Name(s) Title: Place of Birth: Mr Mrs Miss Ms Sex: Date of Birth:









No. of children (if applicable):

Your address, where your correspondence should be sent.

Name, Relationship and Address of next of kin or person who should be contacted in an emergency or if you are unreachable (please state relationship).

E-mail Telephone Mobile

E-mail Telephone Mobile

Please tick this box to confirm that you have told your emergency contact that their names and contact details were provided.


please indicate the course of study. RECENT COURSE OF STUDY EXPECTED QUALIFICATIONS EXPECTED COMPLETEION DATE How did you get to know about the Petrotrin Corporate Scholarships Awards Programme? Employer Internet Search College/Institution Newspaper Company Promotion Other: (Specify) 2 .Are you currently an employee of Petrotrin? Yes No If yes. please state their Name(s) and Badge Number(s). please state Badge Number. No NAME BADGE NO. RELATIONSHIP Where are you currently working or studying? If you are currently working. please provide details of your position. Position. BADGE NO. and the relationship to you. what qualifications you expect to obtain and when you expect to obtain it. Department/Division and Years of Service. grade and main responsibilities. POSITION GRADE MAIN RESPONSIBILITIES If you are currently studying. POSITION DEPARTMENT / DIVISION YEARS OF SERVICE Do you have a relative(s) permanently employed at Petrotrin? Yes If yes.

the start and finish dates. State institutions attended.PART B: ACADEMIC BACKGROUND Please list all academic qualifications obtained from secondary education. Institution Course of Study List Subjects and Grades Obtained From To PART C (a): PROFESSIONAL BACKGROUND (If applicable) Please list your Professional affiliations and/or memberships (if applicable). Course(s) of study (list the subjects and grades obtained). 3 . Organisation / Institution Position (list duties) From To You may copy this page and use for additional entries if more space is required. (Please attach photocopies of all relevant academic certificates or transcripts).

Have you been a recipient or are you currently in receipt of a previous scholarship or award within the past five years. please give full details. the institution. Name. (See Section 1. for which a Bonding Agreement is attached. how do you propose to supplement your scholarship? PART E: PROPOSED COURSE OF STUDY Name of the Course of Study you wish to pursue (list the core subjects/modules to be covered). Yes No If yes. FULL: Overseas Local PARTIAL: Overseas Local If Partial. and the bonding period) Have you applied for/received GATE Approval? Yes No 4 .5 of attached Guidelines for Applying). the amount. address and contact information of the Institution at which you choose to pursue your studies. duration. Have you been accepted at the institution? Yes No If yes. please attach copies of all relevant correspondence (for example: Acknowledgements of your application. please give full details (course of study.PART D: TYPE OF AWARD Select the type of Award you wish to apply for. offer and acceptance letters) Are you applying or have applied for any other scholarships or awards to pursue the same Course of Study as mentioned above? Yes No If yes.

Letters of Recommendation are to be appended to the Application Form FIRST REFEREE Name:: Position: Address: How long have you known this referee? What is his/her professional or other relationship to you? Letters of Recommendation are to be appended to the Application Form SECOND REFEREE Name:: Position: Address: How long have you known this referee? What is his/her professional or other relationship to you? Please tick this box to confirm that you have informed your referees that you have given us their names and contact details.PART F: REFEREES (Petrotrin employees must have a recommendation from their Direct Supervisor supported by their Line Manager) Please attach at least two (2) letters of recommendations: Character / Academic Capability / Track Record of Performance / Career Potential. 5 .

g. financial. What are your reasons for applying for the Course you wish to study? What lead to your decision to choose that particular institution? If you have a specific need. Be brief (approximately 250-300 words).PART G: STATEMENTS ABOUT YOURSELF AND YOUR PLANS Personal Statement Begin your statement by stating why you believe you should be awarded a Petrotrin Corporate Scholarship Award. 6 . please indicate and explain (e. physical or other).

Where do you see yourself at Petrotrin in the next five (5) years? How do you believe you will impact on Petrotrin when you have completed your course of study? Be brief (approximately 250 words). Explain: How will your course of study help your career and personal development goals? How do you intend to ‘make a difference’ in the work environment? The next two questions are to be answered by Petrotrin employees ONLY). 7 .Your plans for the Future Provide an outline of your ambitions and/or career plans.

where you demonstrated exponential talent or abilities in a professional. community or other capacity. 8 .Your most outstanding achievement (work related. Be brief (approximately 250 words). academic or personal) Provide an outline of your most outstanding achievement.

I therefore grant permission to Petrotrin to use my name and/or my photo for any publications (Internal/External).: APPLICATION PROCESSED BY: PRE-SCREENING RESULTS: ELIGIBLITY FOR SRC REVIEW: COMMENTS: YES NO SRC REVIEW RESULTS: RECOMMENDED FOR AWARD: YES NO INTERVIEW: PSYCHOMETRIC TEST: SRC SECRETARY: SRC CHAIRMAN DATE: DATE: 9 . DATE RECEIVED: FOR OFFICIAL USE ONLY DOC. ________________________________________ Signature ______________________________ Date PART I: SUBMISSION OF APPLICATION PACKAGE Refer to Guidelines for Applying for instructions on compiling and submitting a full Application Package. as per statements made in my application. Declare that all statements and declarations made by me in my application are accurate and true.PART H: DECLARATION AND SIGNING I authorize Petrotrin Scholarship Review Committee to access and obtain all relevant documents and details. REF.

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