APPL|0AT|0N F0RV

kP0 UN|vERS|TY STU0ENT S0h0LARSh|P

0|RE0T|0NS
- Read the general information part (page 2) and instructions in every part before filling in this form.
- Use capital letters.
Full Name
Sex Female Male
University
Faculty
Study Program
Sub-Major
Current Semester
CumulativeGrade Point Average

Cumulative Grade Point Average

kP0 UN|vERS|TY STU0ENT S0h0LARSh|P
0enera| |n|ormat|on
KPC offers the University Student Scholarshipto outstanding students from reputable universities.
The scholarship aims at:
- Supporting students financially to complete their S1 education (semesters 5 to 8 for students in the third year; semesters 7to 8
for students in the fourth year).
- Providing them with an opportunity to undertake their Final Assignment (Tua: A||ir ) at KPC.
E||g|b|||ty
Students should fulfil these requirements:
- Currently studying in the third year (semester 5) or in fourth year (semester 7) of the S1 degree program.
- Not older than 22 years old onthe closing date of application.
- Possessing a high level of academic achievement (minimum cumulative GPA of 3.00).
- Able to demonstrate strong leadership, communication and teamwork skills.
- Passing selection tests held by KPC.
- Not receiving a scholarship from another institution during this program.
- Willing to take a final assignment/thesis topic relevant to KPC's needs.
- Willing to sign the University Student Scholarship Programagreement with KPC.

Scho|arsh|p 0overage
This scholarship covers the followings:
- Education assistance with the amount of |0R ,000,000.- per semester.
- Opportunity to complete the Final Assignment at KPC mine site. Among the facilities are:
- Accommodation and meals.
- Travel to and from mine site.
- Medical check up and insurance.
Scho|arsh|p 0urat|on
- This scholarship is given for four semesters maximum (for students in the third year) and two semesters maximum (for students in
the fourth year).
App||cat|on c|oses 30 November 2011
Fill in and collect this application form together with the required attachments to the Department/Faculty Office in your university.
1 PERS0NAL 0ATA
|c|crap| |c|crap|
(cp|icna|)
Full Name
Place and Date of Birth
(Date) (Month) (Year)
Address
City
Postal Code
Mobile
Email

2 A0A0EV|0 ASPE0TS
Summarise grade points average you achieved in previous semesters.
Semester I II III IV V
GPA
Sc|ent|||c Paper
Mention most substantial scientific papers (research paper, publication) you have made.
Title Type (e.g., research paper) Year
Area o| |nterest
Mention areas related to your discipline that you are interested in, which you might be focusing in for your Final Assignment/thesis.
Prev|ous Scho|arsh|ps
Have you received any scholarships during your S1 education program? Yes No
If you answer 'Yes', give detailed information
Scholarship Name Institution Year
Are you currently still receiving a scholarship? Yes No
Have you recently applied for other scholarships whose results may be announced shortly? Yes No
If you answer 'Yes', give detailed information
Scholarship Name Institution

3 0ThER ASPE0TS
Extracurr|cu|ar Act|v|t|es
Mention extracurricular activities that you are actively participating inyour university or your community.
Activity Your Role Year
Explain why you deserve this scholarship.
4 REFEREN0E
Mention a person who knows your qualifications (e.g., your academic advisor).
Name of referee
Organisation
Phone
Email
Attach to th|s |orm:
1. Your |atest 0v
2. A copy o| your |atest academ|c transcr|pt