CONFIDENTIALRev. 1/2008

SHELL MALAYSIA
2008 SCHOLARSHIP APPLICATION FORM
CLOSING DATE: 31 MARCH, 2008 / Please affix your recent passport-sized photograph.

IMPORTANT INFORMATION

  1. The scholarship is awarded to Malaysian students for pursuing full-time undergraduate studies (1st degree course) tenable at recognized universities in Malaysia or overseas.
  2. Students who have completed their STPM/A-Levels/Foundation Year/Diploma or currently in their final semester of Matriculation studies or in the University (IPTA/IPTS) are eligible to apply.
  3. Please complete the form in BLOCK LETTERS.
  4. If the space is insufficient, please give further information on a separate sheet of paper.
  5. INCOMPLETE and LATE application will be rejected.
  6. If you do not receive any reply from us by 31st March 2008, your application is therefore considered unsuccessful.
  7. *Please delete whichever is NOT applicable.
  8. For those applicants with no Internet facilities, please send your duly completed form directly to:
    SCHOLARSHIP COORDINATOR, Bangunan Shell Malaysia, 2nd Floor, Changkat Semantan, DamansaraHeights, 50490, Kuala Lumpur.

APPLICATION TYPE []: (The Company reserves the right to change the Application Type.)

MalaysiaOverseas

1.PERSONAL PARTICULARS

NAME (as per your Identity Card)


GENDER:Male/Female*ETHNIC:Bumi/Non-Bumi*NRIC NO.______:
AGE:___years oldRACE:______DATE OF BIRTH:______
RELIGION:______STATE OF ORIGIN: Sabah/Sarawak/Others* HOMETOWN:
PREFERRED PLACE OF INTERVIEW:KUCHING/SIBU/MIRI/KOTA KINABALU/TAWAU/SANDAKAN/LABUAN/Kuala Lumpur/Others
(Your selected location should be nearest to your current hometown. All travel expenses incurred will be on the applicant’s personal account. The Company reserves the right to change the location of interview.)
CORRESPONDENCE ADDRESS: (Please ensure that your address, email and contact nos. are active.)
______Tel. No.:______
______HP No.:______
______E-Mail:______
______Post Code:______
Any physical disability (eg. sight, hearing, speech) : / Any previous illness/operation :

2.FAMILY PARTICULARS

Particulars / Father / Mother
  • Name

  • Occupation

  • Basic Salary/Income (RM)

  • Employer

  • Race

  • Ethnic
/ Bumiputra/Non-Bumiputra* / Bumiputra/Non-Bumiputra*
  • State of Origin
/

Sarawak/Sabah/Others*

/

Sarawak/Sabah/Others*

Note:Please produce a supporting document if your parent do not have a payslip (applicable to retiree, pensioner, fisherman, farmer, unemployed, amah/baby-sitter), handicap, separated, divorced or deceased.

FOR OFFICIAL USE
Education Level / Status / Remarks
STPM/A-Level [...... ]
Diploma/Matrix/Fdn Yr/Undergraduates
GPA/CGPA:......
LEVEL/SEMESTER:...... / REJECTED [Not Meeting Criteria/ Incomplete/Origin]
CONSIDERED [Meeting minimum criteria]
SHORTLISTED [Invitation for Interview] / Type:Malaysia/Overseas
Parent’s Income:<RM3K/>RM3K
......
......

Do you have any brother or sister currently holding the Shell Scholarship? YES/NO* If yes, please complete the following:

Name / Relationship / Institution

Relatives working in Shell

Name / Relationship / Dept. & Office Contact No.
3.EDUCATION QUALIFICATION
Please [] your highest qualification.
STPM/A-LEVEL* YEAR : 200_____
DIPLOMA/MATRIX/FOUNDATION YEAR/UNDERGRADUATES*
OTHERS: ......
(please specifiy)
LEVEL:YEAR: [1]/[2]/[3]*
SEMESTER: [1]/[2]/[FINAL]* / School (for STPM):......
College/University:......
Course:......
Intake Year:200....
Course Duration:[3]/[4]/[5]/OTHERS*...... YEARS (please specify)
Expected Completion (Mth/Yr)...... :...... /20
Please state your choice of courses that you intend to apply. If you are already in the university, please ignore this section.
CHOICE / COURSE
1ST
2ND
4. EXTRA CURRICULAR ACTIVITIES (2004-2006)
Please use separate sheet if space is insufficient.
CLUBS/SOCIETIES/OTHERS
YEAR / ACTIVITIES / REPRESENTED / POSITION HELD
(Please refer to the list below)
EG. 2004
2004 / Interact Club
Swimming / -
National / President
-
REPRESENTED: House; School; District; Division; State; National
POSITION HELD: Chairman; President; Vice/Dep. President/Chairman; Captain/Leader; Treasurer; School Prefect; Secretary; Assistant; etc.
5.SPECIAL AWARDS RECEIVED
YEAR / TYPE OF AWARDS / GRANTED/SPONSORED BY
6. OTHER 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/Organisation/Foundation (eg. JPA, MARA, PETRONAS, PTPTN, etc.) / Year / Amount (RM)
1)
2)
7. DECLARATION
I declare that all the above particulars are true and correct. I understand that, should I accept a scholarship and any of the above information is found to be false, the scholarship will be held liable to repayment of monies expended. I also understand that the completion of this form does not commit the Shell Scholarship Fund to assisting me in any way.
I enclosed herewith my certified copy of the supporting documents [ ].
(1)Birth Certificate & Identity Card
(2)Results – STPM/Matrix/Foundation/Diploma/Year 1
(3)School Testimonial (Surat Akuan), Certificates of Achievements, School Co-Curricular Activities, etc.
(4)2 latest semester results (applicable to those currently in the Matriculation/Foundation Year/Diploma/University)
(5)Letter of Offer from the University (applicable to those currently in the University)
(6)Parents' Identity Card, 2-month Latest Salary Slip/Income Tax Statement (Form J) or any other supporting document of my parent’s status.
Applicant's Signature:______Date______:

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