APPLICATION FOR SCHOLARSHIP

PERSONAL DATA

Full Name :

Photo3x4 cm

Present Address :

Permanent Address :

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

School From - To Name & Location of School Major CourseGraduated/ Degree

ReceivedGPA

Elementary

Jr. High

Sr. High

University

ORGANIZATIONAL ACTIVITIES

Name of Organization/ Activities From - To Position

TRAINING/ COURSE/ APPRENTICESHIP RECORDSKind of Training/ Course/

ApprenticeshipFrom - 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 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

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