SHELL MALAYSIA 2014 SCHOLARSHIP APPLICATION FORM Confidential

CLOSING DATE 2!t" Fe#$%a$& 2014 IMPORTANT INFORMATION 1. The scholarship is awarded to Mala&'ian 't%dent' who intend to pursue/Pursuing full-time undergraduate studies tenable at recognized universities in Malaysia or abroad. 2. tudents who have completed their TPM/!-"evel/#oundation $ear/%iploma or currently in their final semester of Matriculation studies are eligible to apply. &. Please complete the form di(itall&) '. In*o+,lete and late application will be $e-e*ted. (. )f you do not receive any reply from us by .0 A,$il 2014* your application is therefore considered %n'%**e''f%l. +. ,Please delete whichever is NOT applicable. This cholarship !pplication #orm should be submitted online via the hell Malaysia -nline !pplication website on www.shell.com.my/scholarship-application CHOICE OF ST/DY .hoose /one0 either O0e$'ea' or Lo*al cholarship only. 1ot allowed to apply for both -verseas and "ocal. a1 O0e$'ea' Technical2 Petroleum 3ngineering Mechanical 3ngineering 4eosciences

-thers2 555555555555555555 / pecify0 At 2"i*" %ni0e$'it&3 555555555555555555555555555 / pecify0

#1 Lo*al 4Mala&'ia1 Technical2 Petroleum 3ngineering Mechanical 3ngineering 4eosciences

-thers/.ommercial2 555555555555555555 / pecify0 At 2"i*" %ni0e$'it&3 555555555555555555555555555 / pecify0 5HY HA6E YO/ CHOSEN THIS CHOICE OF ST/DY3 Ma6e a brief statement* of not more than 277 words* of your choice as they relate to your aspirations* career ob8ectives and long term goals.

1)

PERSONAL PARTIC/LARS

Na+e (as per your MyKad) NRIC No) A(e State of o$i(in2 Peninsular Malaysia/ arawa6/ abah Co+#ined Fa+il& in*o+e /in 9M per month0 Fa+il& In*o+e 'tate+ent /!re there any unusual family circumstances you want considered as part of your application: Ma; 177 words0

An& ,"&'i*al di'a#ilit& 4e() 'i("t7 "ea$in(7 ',ee*"1 2

An& ,$e0io%' illne''8o,e$ation 2

2) ACADEMIC RES/LTS

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Please state your specific academic sub8ects plus e9a*t grade /!<* !-* .< etc0 from TPM/!-level onwards to the highest level of study achieved to date

.) E:TRA C/RRIC/LAR ACTI6ITIES CL/;S8SOCIETIES8OTHERS $3!9

e.g. 2012 - 2013

!.T)=)T)3
e.g. - Interact Club Swimming

93P93 31T3%
e.g. - National

P- )T)-1 >3"% /Please refer to the list below0

e.g. - President

93P93 31T3% 2 >ouse? chool? %istrict? %ivision? tate? 1ational P- )T)-1 >3"% 2 .hairman? President? =ice/%ep. President/.hairman? .aptain/"eader? Treasurer? chool Prefect? ecretary? !ssistant? etc. 4) SPECIAL A5ARDS RECEI6ED $3!9 T$P3 -# !@!9% 49!1T3%/ P-1 -93% A$

<) OTHER FINANCIAL INFORMATION !re you currently receiving any financial assistance or sponsorship from other institution* fund or foundation: YES8NO, )f $3 * please give details2 In'tit%tion8F%nd8O$(ani=ation8Fo%ndation 4e)() >PA7 MARA7 PETRONAS7 PTPTN7 et*)1 Yea$ A+o%nt 4RM1 10 20 &0 ?) RECOMMENDER Provide name and contact information of a teacher* counselor* instructor or wor6 supervisor Na+e2 Role2 Conta*t info2

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