CONFIDENTIAL

SHELL MALAYSIA 2014 SCHOLARSHIP APPLICATION FORMConfidential

CLOSING DATE: 28th February 2014

IMPORTANT INFORMATION1. The scholarship is awarded to Malaysian students who intend to pursue/Pursuing full-time undergraduate studies tenable at recognized universities in Malaysia or abroad.2. Students who have completed their STPM/A-Level/Foundation Year/Diploma or currently in their final semester of Matriculation studies are eligible to apply.

3. Please complete the form digitally.4. Incomplete and late application will be rejected.

5. If you do not receive any reply from us by 30 April 2014, your application is therefore considered unsuccessful.

6. *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/scholarship-application

CHOICE OF STUDYChoose (one) either Overseas or Local Scholarship only.

Not allowed to apply for both Overseas and Local.b) Local (Malaysia)Technical:

Petroleum Engineering At which university? Universiti Teknologi Malaysia (UTM)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.I choose this course of study because I find it very interesting which I can put my soft skills to a test for how far can it bring me. Of course, with I see there is many things that I need to improve in term skills and academics. Keep Moving Forward, I hold on to the principle which made me who I am today. I notice the weakness that I have, and do something about it. I became an active member of AIESEC club in UTM which helps me a lot in developing my confidence level. I understand that, the career opportunity for this course is not so wide. And that is why Im gonna try my hardest to bring out for even one percent more of crude oil of what we are producing right now. That will be my career objective which can helps Malaysias economic. I believe that SHELL can help me to make it into a reality.

1.PERSONAL PARTICULARS

Name (as per your MyKad) Mohamad Khairil Ikram Bin ABdull HalimNRIC No. : 941022-03-5031

Age: 20State of origin: Peninsular Malaysia( Kelantan)Combined Family income : RM 2200.00(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 :

-

-

2. ACADEMIC RESULTS

Please state your specific academic subjects plus exact grade (A+, A-, C+ etc) from STPM/A-level onwards to the highest level of study achieved to dateMatriculation

Subject

Grades

Physic

A

Chemistry

A

Mathematics

A

Computer Science

A

Semester onesubject

grades

Fundamental of Petroleum Engineering

A

Mechanics

B+

Electrical of engineering

A

Engineering Mathematic 1

A+

English

A-

Introduction to Engineering

A

3. EXTRA CURRICULAR ACTIVITIES

CLUBS/SOCIETIES/OTHERS

YEARACTIVITIESREPRESENTEDPOSITION HELD

(Please refer to the list below)

e.g. 2012 - 2013e.g. - Interact Club Swimminge.g. - Nationale.g. - President

2014MITC clubCollegeTreasurer

2014Board Member of JKM KTHOCollegeCommittee

2014CAREUniversityCommitee

2012SLAD clubSchoolTreasurer

REPRESENTED: House; School; District; Division; State; National

POSITION HELD: Chairman; President; Vice/Dep. President/Chairman; Captain/Leader; Treasurer; School Prefect; Secretary;

Assistant; etc.

4. SPECIAL AWARDS RECEIVED

YEARTYPE OF AWARDSGRANTED/SPONSORED BY

2014Best Performing member in team departmentAIESEC UTM

2014Best Performing member in LC UTMAIESEC UTM

2010Golden AwardMCKK

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, etc.)YearAmount (RM)

1) JPA20145400

2)

3)

6. RECOMMENDER

Provide name and contact information of a teacher, counselor, instructor or work supervisorName: Dr. Wan RosliRole: Academic AdvisorContact info: 014 312 5432

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