CLOSING DATE: 28 th February 2014
IMPORTANT INFORMATION
1.
The scholarship is awarded to Malaysian students who intend to pursue/Pursuing full-time undergraduate studies tenable at recognized universities in Malaysia or abroad.
2.
Students who have completed their STPM/A-Level/Foundation Year/Diploma or currently in their final semester of Matriculation studies are eligible to apply.
3.
Please complete the form digitally.
4.
Incomplete and late application will be rejected.
5.
If you do not receive any reply from us by 30 April 2014, your application is therefore considered unsuccessful.
6.
*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/scholarship-application
CHOICE OF STUDY
Choose (one) either Overseas or Local Scholarship only.
Not allowed to apply for both Overseas and Local. a) Overseas
Technical:
Petroleum Engineering Mechanical Engineering Geosciences
Others: __________________ (Specify)
At which university? ___________________________ (Specify) b) Local (Malaysia)
Technical:
Petroleum Engineering Mechanical Engineering Geosciences
Others/Commercial: __________________ (Specify)
At which university? ___________________________ (Specify)
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. PERSONAL PARTICULARS
Name (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) : Any previous illness/operation :
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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. – 2012 - 2013
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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