APPLICATION FOR SCHOLARSHIP

ITB IFP Dual Master Program

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

EDUCATION BACKGROUND
Graduated/ Degree
School From - To Name & Location of School Major Course GPA
Received

Elementary

Jr. High

Sr. High

University
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 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