SHELL MALAYSIA 2012 SCHOLARSHIP APPLICATION FORM Confidential

CLOSING DATE: 12th February 2012 IMPORTANT INFORMATION

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

The scholarship is awarded to Malaysian students pursuing full-time undergraduate studies (1st degree course) tenable at recognized universities in Malaysia or abroad and Pre-University studies in Malaysia. Students who have completed their O-Level, 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 2nd March 2012, 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: __________________ (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.

PERSONAL PARTICULARS
(as per your MyKad)

Name

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 SPM/ O-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 : Secretary;

House; School; District; Division; State; National Chairman; President; Vice/Dep. President/Chairman; Captain/Leader; Treasurer; School Prefect;

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, Year Amount (RM) etc.) 1) 2) 3) 6. RECOMMENDER Provide name and contact information of a teacher, counselor, instructor or work supervisor Name: Role: Contact info:

*Please refer below for the list of preferred Malaysian Public & Private Universities and Overseas Universities.

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List of preferred Malaysian Public and Private Universities: Private Universities 1 2 3 4 5 6 7 8 Multimedia University Universiti Tenaga Nasional University of Nottingham Malaysia Taylors University Monash University Malaysia Curtin University of Technology Sarawak HELP University Limkokwing University of Creative Technology

Public Universities 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 Universiti Malaya (UM) Universiti Kebangsaan Malaysia (UKM) Universiti Sains Malaysia (USM) Universiti Putra Malaysia (UPM) Universiti Teknologi Malaysia (UTM) International Islamic University Malaysia (IIUM) Universiti Teknologi MARA UiTM Universiti Malaysia Perlis Universiti Malaysia Pahang Universiti Utara Malaysia Universiti Tun Hussein Onn Malaysia University Malaysia Sabah Universiti Teknologi Petronas Universiti Sains Islam Malaysia Universiti Pendidikan Sultan Idris Universiti Teknikal Malaysia Melaka Universiti Malaysia Terengganu Universiti Malaysia Sarawak National Defense Universiti of Malaysia Universiti Sultan Zainal Abidin

List of preferred overseas universities and degree disciplines:

1) Imperial College London Geosciences,

Mechanical or Electrical Engineering

2) Massachusetts Institute of Technology Mechanical, Civil or Electrical Engineering

3) Texas A&M University Petroleum Engineering only

4) University of Bristol Geosciences, Mechanical, Civil or Electrical Engineering 5) University of Cambridge Geosciences, Mechanical or Electrical Engineering 6) University of Sheffield Mechanical or Electrical Engineering

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