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1 {'fJ U^"N"^"r^.-i..W L; "L^-*--[,,.- 11 @L!NomorLampiranHal

UNIVERSITAS GADJAH MADABuraksumur, Yoqyaka^a ss23r, rerp. (0274) s33633, Fax. (0274) s6s22lWebs l : rylsm.ac.id, E ma : 5ct@q[i.!!]!

hhb tou-NtawUr,vtzo|Penawarun Beasiswa S-2 Total E&p lndonesie

2 2 flAR 201iYth. Wakit Dekan yang membidanqi Kemahasiswaan1. Fakultas MIPA2. Fakultas TeknikUniversitas cadjah MadaDengan ini kami beritahukan bahwa Total E&p lndonesie pada Tahun Aiatan ZA11aO12menawarkan kembali program Beasiswa ,TB Master in peiriteui EngineetingScl,olarshlp untuk lulusan/mahasiswa Universitas Gadjah Mada O"ng;n p"i"y"rat"n "OO ,1. Sarjana atau t\,4ahasiswa duduk disemester akhir Fakultas MlpA jurusan Fisika, Kimia,^ Matemalika dan Fakultas Teknikjurusan I Kimia, T. l\,4esin, T. e fef

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FORIVI PROPE 52 UGII,'I 2O1O

Form PROPE-S2TOTAL SCHOLARSHIP FOR ITB PROFESSIONNAL MASTERS IN

PETROLEUM ENGINEERINGIn Collaboration with IFP School (French Institute of Petroleum School)Total E&P lndonesie will glant a substantial number of scholarships for students from the bestlndonesian Universities with good Technical or Scieniific majors in support of the ITB professionallVasters in Petroleum Engineerinq.This program is considered as one of TOTAL E&p lndonesje,s commitment to develop human resourcesin their core business by gjving a financial support to outstanding lndonesian students and also furtherdeveloping the institutes of higher learning by encouraging international cooperation.The scholarship candidates should:. Be in their 8th semester or have already graduated in the prevjous semester,. Have good academic records with cPA min.3.00,. English proficiency of 500 TOEFL or Iollow the TOEFL test arranged by ITB and obtain the

passing mark of 500.. Pass the Academic Potency Test conducted by OTO BApPENAS at ITB with a minimum score of500.

Total E&P lndonesie will conduct the selection process together with lTB. The grantees will be entifled tohave their tuition fees paid. The fee for the Professional Master pE has been lixed at Rp 7S.OOO.OOO,payable Rp25.000.000,/semester.

A certain number of the successful Scholarship holders will be offered pre-employment agreements withTOTAL E&P INDONESIE where in addition to the Tuition Fees, a competitive living allowance will beoffered to cover lodging, books and other expenses during the period of the course.An obligation to wo.k with TOTAL E&P INDONES|E wi be required for a period of 2n+1 in which n is thenumber of years of the pre-employment agreement between the Scholarship holder and TOTAL E&pINDONESIE.

This form can be returned before 8 April 2011 to TOTAL'S local universitycorrespondent with the address here below

Toraueep tNDoNst

DIREKTORAT KEIVIAHASISWAANKANTOR PUSAT UGIV, SAYAP UTARA LANTAI .1UGM - YOGYAContact Person: lbu lda/ lbu AiniPhone: 0274 - 901929

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..,.T-oraueep FORIVI PROPE-S2 UGIvI 2010INDON5IAPPLICATION FOR SCHOLARSHIPPERSONAL DATA

Permanent Addrss

Place & Date of Birth

Bank Address

EDUCATION BACKGROIJNOGraduated/ DedreeName & Location ofSchool

UNIVERSITY CONTACT NUMBERYrrr'''Telephone & Fax. Number

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l-orau &r, INDoNsl.rr oRGANIzAItoNAL AcTtvlTtEs: Name of Orsanization/ Activities

FORTVI PROPE-S2 UGtlt 2010

TRAINING/ COURSE/ APPRENTICESHIP RECORDSKind of Training/ Course/ Organized By

ACTIVITIES & HOBBIESMembership of Professiona{

Hobbies & Sports

ADDITIONAL INFORMATION

Th facts stated in thisScholarship Fonn aretrue and completetothe bstolny knowiedge and betief.lunde.siand and agreelo followallthe procedures, resulations, and requiremenis thalrelatedto TotalE&P Indonesie's Scholarship Prcgram.

Date: Applicant's Signaturei

N.B:Plase supplyallofthis documents, along with thh forml. Copy of academic transcripts, fron lstsemesteruntilihe lastsemsier.. I pholo (3x4 crn)-. Copyofthe first page ofyour account book (that stated the Bank's nane, your name and account numberi.

T()TAL

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FORM PROPE-S2 UGM 20,10

Date :

1. Why are you entitled to accept this scholarship?

TAL &P INDON5I

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. ..' TorAL &P tNDoNs1 FORM PROPE-S2 UGM 201O2. Why do you want to continue your study to Master Degree?

,&w

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._, Torau&r' INDoNst FORM PROPE-S2 UGM 201O

3. What is you. plan after graduatecl from ITB Professional l{asters in Petroleum Engineering?

#TorAL