1. 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 Age Education Occupation
Father
Mother
Sibling: 1
2
3
4
5
EDUCATION BACKGROUND
Graduated/ Degree
School From - To Name & Location of School Major Course GPA
Received
Elementary
Jr. High
Sr. High
University
2. ORGANIZATIONAL ACTIVITIES
Name of Organization/ Activities From - To Position
TRAINING/ COURSE/ APPRENTICESHIP RECORDS
Kind of Training/ Course/
From - To Organized By Location
Apprenticeship
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 TOEFL certificate
