ConocoPhillips SPIRIT Scholarship 2014
APPLICATION FORM
Awarded to an undergraduate student at RMIT University commencing the penultimate year of a:
(i)
(ii)
(iii)
Bachelor of Environmental Science degree, or
Bachelor of Environmental Science / Bachelor of Environmental Engineering double degree, or
Bachelor of Environmental Science / Bachelor of Business Management double degree.
1. Personal Details
Family Name:
Given Name:
Student ID:
Gender (M or F):
Date of Birth:
Home Address:
Postcode:
Postal Address: (if different to above)
Postcode:
Email:
Phone (home):
Mobile:
2. Residency
Do you have Australian citizenship or Australian Permanent Residency?
Yes
No
If you are not an Australian Citizen or Permanent Resident, you are ineligible for this scholarship.
3. Eligibility
What degree and year are you enrolled for in for 2013? __________________________________________________
_____________________________________________________________________________________________
What is your intended Major(s)? ________________________________________________________________
Are you enrolled as a part time (P/T) or full time (F/T) student?
If you are enrolled part time, you are ineligible for this scholarship.
P/T
F/T
Are you currently or have you previously been in receipt of any other scholarships, sponsorships or cash
prizes, or have you applied for or accepted any vacation work positions?
Yes
If yes, please provide details: __________________________________________________________
No
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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4. Referees
Please provide the name and contact details for two appropriate referees who would be happy to be contacted about
your application for this scholarship, where possible.
Students must approach the referee(s) and ensure that they are happy to provide a reference on your behalf;
An appropriate referee is one who is not related in any way to you and preferably has supervised you in the
workplace environment
Referee 1
Referee Name
Organisation/
Company
Contact Phone
Email Address:
Referee 2
Referee Name
Organisation/
Company
Contact Phone
Email Address:
5. Selection Criteria
Please address the following criteria in preparing your application for the ConocoPhillips SPIRIT Scholarship.
5a. “SPIRIT” (Safety, People, Integrity, Responsibility, Innovation and Teamwork) are the values that
ConocoPhillips applies in everything we do. Can you please provide two examples of where you have had to
demonstrate your commitment to any of these values? (The ConocoPhillips SPIRIT values are listed on page
5 of this application.)
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5b. What do you enjoy most about your course of study?
5c. What are your future career goals and describe how a SPIRIT Scholarship might assist you to achieve
these?
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6. Checklist
I have completed the application form in full
Yes
No
I have attached my current Curriculum Vitae / Resume
Yes
No
I have attached a copy of my academic transcript
Yes
No
I have attached proof of my citizenship
Yes
No
I have signed the declaration in Section 7
Yes
No
7. Declaration
I declare that the information supplied is complete and correct in every particular. I agree to make available to
ConocoPhillips details of my enrolment, academic record, and examination results, including variations and attendance,
at any time requested by ConocoPhillips.
I agree to abide by the conditions of the scholarship as amended from time to time. I am aware that there are severe
penalties for providing false or misleading information.
I grant ConocoPhillips permission to use the course details of the scholarship holders for publicity purposes.
Signature: _______________________________________________ Date: _____/_____/_____
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Your completed application must be submitted by Friday, 28 March 2014 either electronically or by post
to:
By email: ABUGrad@conocophillips.com
By post: Organisational Development Co-ordinator, ConocoPhillips Australia:
53 Ord Street, West Perth, WA 6005.
If you have any questions regarding the application process, please contact
the Organisational Development Co-ordinator on (08) 9423 6666 or ABUGrad@conocophillips.com
GOOD LUCK WITH YOUR APPLICATION
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