2014 Azerbaijani Oil & Gas Scholarship Program for Undergraduate studies Application Form Name Surname Photo taken within last 6 months Patronymic Please complete the application form in English. Uncompleted applications will be disqualified. Personal Information Date (day/month/year) and place of birth Citizenship Gender Male Female Home address in Azerbaijan (Street name, number, apartment, city, postal code, country, rayon) Current mailing address (Street name, number, apartment, city, postal code, country, district) Contact phone numbers (country code, city code, phone number). Mobile (Azerbaijan): Mobile (Turkey): Home phone : E-mail address Emergency contact phone/e-mail Educational Background School Location Year of graduation Special awards (if you were participant or winner of Olympiad please indicate subjects, year and place you got) 1 University and Discipline Choose one University and one Department you have applied and got admission (tick the relevant box). Ticking multiple boxes will disqualify the application University: Istanbul Technical University Middle East Technical University Yildiz Technical University Istanbul University Department: Chemical Engineering Electrical & Electronic Engineering (Control and Automation engineering) Mathematics Mechanical Engineering Civil and Structural Engineering Petroleum Engineering Metallurgical and Materials Engineering Please indicate your entry score in relevant section University exam score, date and place SAT score, date and place Other entry exam results, name, date and place Fluent Moderate Basic None English If you have ever taken Official English Language Examination (TOEFL) please indicate TOEFL score, date and place If you have taken English Language Proficiency Examination at university of studies please indicate (For graduates of Preparation Courses) Test score, date and place 2 Please indicate your CGPA (Cumulative Grade Point Average for the 1st, 2nd and 3rd course students) CGPA (Cumulative Grade) Disclaimer: Do you have a close personal or business association or family relationship with, an officer or employee of a government owned company (e.g. a national oil company) or with any government official or any officer or employee of a government agency? Yes No __________________________________________________________________________________________________ Please give the names and contact numbers of at least two persons who are in a position to comment on your academic education (if applicable). This may include school teacher, university professor, but not your relatives. Name and surname Workplace and Position Telephone number and e-mail PERSONAL STATEMENT Please describe all academic or personal achievements, any extra curricula activities you have had, explain your motivation to apply to particular University and Faculty. Please use about 350 words for this section: 3 How did you know about the program? BP Website Facebook Other Website School /lyceum/University Network(friends, relatives) Student’s Unions Education and Career Fairs Other (Please specify) Application check list : 1. 2. 3. 4. 5. 6. Scanned copy of university entry examination result Scanned copy of university admission Scanned copy of document that confirms completion of English Language Preparation course at mentioned Turkish Universities (for current students) Scanned copy of TOEFL (or other) test results for newly admitted students Scanned copy of transcript ( for all years of study) Scanned copy of national ID 4 “I confirm that, to the best of my knowledge, the information contained in this application is accurate. I give consent to the verification of this information provided and understand that false information or significant omissions may disqualify me from consideration for the scholarship and may be considered as justification for withdrawal of scholarship if discovered at a later date.” Signature __________________________________ __________________________Date Please send your completed application and scanned documents to the following email scholarship@bp.com stating your name and surname in the subject of the message. 5