Académique Documents
Professionnel Documents
Culture Documents
PERSONAL DATA
Full Name :
Present Address :
Telephone :
E-mail Address :
FAMILY DATA
Father
Mother
Sibling
1
:
2
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
Social Activities
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