SHELL MALAYSIA 2013 SCHOLARSHIP APPLICATION FORM Confidential

CLOSING DATE: 30 th January 2013 IMPORTANT INFORMATION

1. 2. 3. 4. 5. 6. 7.

The scholarship is awarded to Malaysian students who intend to pursue full-time undergraduate studies (1st degree course) tenable at recognized universities in Malaysia or abroad. Students who have completed their STPM/A-Level/Foundation Year/Diploma or currently in their final semester of Matriculation studies are eligible to apply. Please complete the form digitally. Incomplete and late application will be rejected. If you do not receive any reply from us by 30 April 2013, your application is therefore considered unsuccessful. *Please delete whichever is NOT applicable.

This Scholarship Application Form should be submitted online via the Shell Malaysia Online Application website on www.shell.com/my - Jobs & Careers - Students & Graduates Scholarship. CHOICE OF STUDY Overseas Petroleum Engineering Mechanical Engineering Civil Engineering Electrical Engineering Geosciences

Others: __________________ (Specify) At which university? ___________________________ (Specify) Malaysia Others (please fill in which field of study you intend to pursue): WHY HAVE YOU CHOSEN THIS CHOICE OF STUDY? Make a brief statement, of not more than 200 words, of your choice as they relate to your aspirations, career objectives and long term goals.

1. Name

PERSONAL PARTICULARS
(as per your MyKad)

NRIC No. Age: State of origin: Peninsular Malaysia/Sarawak/Sabah Combined Family income (in RM per month) Family Income statement (Are there any unusual family circumstances you want considered as part of your application? Max 100 words)

Any physical disability (eg. sight, hearing, speech) : Page 1/2

Any previous illness/operation :

2. ACADEMIC RESULTS Please state your specific academic subjects plus exact grade (A+, A-, C+ etc) from STPM/A-level onwards to the highest level of study achieved to date

3. EXTRA CURRICULAR ACTIVITIES CLUBS/SOCIETIES/OTHERS YEAR

e.g. 2008 - 2009

ACTIVITIES
e.g. - Interact Club Swimming

REPRESENTED
e.g. - National

POSITION HELD (Please refer to the list below)

e.g. - President

REPRESENTED : POSITION HELD :

House; School; District; Division; State; National Chairman; President; Vice/Dep. President/Chairman; Captain/Leader; Treasurer; School Prefect; Secretary; Assistant; etc. 4. SPECIAL AWARDS RECEIVED YEAR TYPE OF AWARDS GRANTED/SPONSORED BY

5. OTHER FINANCIAL INFORMATION Are you currently receiving any financial assistance or sponsorship from other institution, fund or foundation? YES/NO* If YES, please give details: Institution/Fund/Organization/Foundation (e.g. JPA, MARA, PETRONAS, PTPTN, etc.) Year Amount (RM) 1) 2) 3) 6. RECOMMENDER Provide name and contact information of a teacher, counselor, instructor or work supervisor Name: Role: Contact info:

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