151364679013

Form PROPE-S2

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151364679013

TOTAL SCHOLARSHIP FOR ITB PROFESSIONNAL MASTERS IN

PETROLEUM ENGINEERING

In Collaboration with IFP School (French Institute of Petroleum School)

Total E&P Indonesie will grant a substantial number of scholarships for students from the best
Indonesian Universities with good Technical or Scientific majors in support of the ITB Professional
Masters in Petroleum Engineering.

This program is considered as one of TOTAL E&P Indonesies commitment to develop human resources
in their core business by giving a financial support to outstanding Indonesian students and also further
developing the institutes of higher learning by encouraging international cooperation.

The scholarship candidates should:

Be in their 8th semester or have already graduated in the previous semester,

Have good academic records with GPA min. 3.00,
English proficiency of 500 TOEFL or follow 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 of
500.

Total E&P Indonesie will conduct the selection process together with ITB. The grantees will be entitled to
have their tuition fees paid. The fee for the Professional Master PE has been fixed at Rp 39.000.000,
payable Rp 13.000.000,/semester.

A certain number of the successful Scholarship holders will be offered pre-employment agreements with
TOTAL E&P INDONESIE where in addition to the Tuition Fees, a competitive living allowance will be
offered to cover lodging, books and other expenses during the period of the course.

An obligation to work with TOTAL E&P INDONESIE will be required for a period of 2n+1 in which n is the
number of years of the pre-employment agreement between the Scholarship holder and TOTAL E&P
INDONESIE.

This form can be returned before 25 April 2013 to TOTALs local

university correspondent with the address here below
STUDENT ADVISORY CENTER
ITS
Contact Person: Ibu Rinun
Phone: (031) 592 5880/ (031) 709 79292

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APPLICATION FOR SCHOLARSHIP

PERSONAL DATA
Full Name

Present Address

Permanent Address

BLOSSOM VILLE BLOK J/20 NO 5 THE GREEN, BUMI SERPONG

DAMAI-SOUTH TANGERANG, BANTEN

Telephone

(62)85697040699

Email Address

Place & Date of

Birth

TANJUNG, SOUTH BORNEO, FEBRUARY 12TH 1991

Account Number

1280005803116

Bank Address

BANK MANDIRI

INDRA PERKASA
BHASKARA SARI NO 69. MULYOSARI - SURABAYA

Indra_perkasaa@yahoo.co.id

FAMILY DATA
Name

Age

TIASHADI YITMOYONO

61

SRI UTARI

57

ARYO UTOMO

29

TEGUH MAULANA

26

Education

Father
Mother
Siblin
g:

1
2

Occupation

BACHELOR OF MINING
ENGINEERING IN INSTITUT
TEKNOLOGI BANDUNG
SENIOR HIGH SCHOOL

RETIRED FROM PT.

PERTAMINA

BACHELOR OF
MANAGEMENT IN ATMA JAYA
JAKARTA
BACHELOR OF PETROLEUM
ENGINEERING IN INSTITUT
TEKNOLOGI BANDUNG

EMPLOYEE

HOUSE WIFE

EMPLOYEE

3
4
5
EDUCATION BACKGROUND
School

From - To

Elementar
y

1997 2003

Jr. High

2003 2006

Sr. High

2006 2009

University

2009 PRESENT

Major Course

Graduated/ Degree
Received

SCIENCE

ENVIRONMENTAL
ENGINEERING

Name & Location of School

AL-AZHAR BUMI SERPONG
DAMAI
AL-AZHAR BUMI SERPONG
DAMAI
AL-AZHAR BUMI SERPONG
DAMAI
INSTITUT TEKNOLOGI
SEPULUH NOPEMBER

UNIVERSITY CONTACT NUMBER

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GPA

2.97

151364679013
University

Faculty/ Major

University Address

(with post code)

Telephone & Fax. Number

(with area code)

INSTITUT TEKNOLOGI SEPULUH NOPEMBER

FAKULTAS TEKNIK SIPIL DAN PERENCANAAN
KAMPUS ITS, SUKOLILO, SURABAYA, EAST JAVA, INDONESIA 60111

62-31-5948886 & 62-31-5928387

ORGANIZATIONAL ACTIVITIES
Name of Organization/ Activities

From - To

Position

HMTL ITS

2010 2011

HMTL ITS

2011 2012

STAFF OF RESPONSIBILITY
DEPARTEMENT
STAFF OF ART AND SPORT

LOMBA INOVASI TEKNIK

LINGKUNGAN
SOCIETY OF PETROLEUM
ENGINEERING ITS STUDENT
CHAPTER
SOCIETY OF PETROLEUM
ENGINEERING INTERNATIONAL

2011 2012

CHIEF EVENTS

2012 PRESENT

MEMBER

2013 - PRESENT

MEMBER

TRAINING/ COURSE/ APPRENTICESHIP RECORDS

Kind of Training/ Course/
From - To
Apprenticeship
GEOTHERMAL SEMINAR
2013
AND CARRER TALK WITH
CHEVRON
COURSE
2013

SOCIETY OF
EXPLORATION
GEOPHYCICS
SCHLUMBERGER

SURABAYA

TRAINING OHSAS
18001:2007
YOUNG WATER
PROFESSIONAL
COURSE

2013

SURABAYA

2013

PT PHITAGORAS GLOBAL
DUTA
INTERNATIONAL WATER
ASSOCIATION
CHEVRON

ON-JOB TRAINING

2012

PERTAMINA EP

CIREBON

2013

Organized By

Location

SURABAYA

JAKARTA
SURABAYA

ACTIVITIES & HOBBIES

Membership of
Professional Association

MEMBER OF SOCIETY OF PETROLEUM ENGINEERING STUDENT CHAPTER ITS

Hobbies & Sports

FUTSAL, CYCLING, MUSIC, AND TRAVELLING

Social Activities

ADDITIONAL INFORMATION (if any)

3rd PLACE ON FESTIVAL MUDA ACCOUSTIC MUDA CREATIVITY 4TH ANNIVERSARY

PARTICIPANT IN FUTSAL RECTOR CUP 2012
2nd PLACE FUTSAL OLIMPIADE FTSP 2012
3rd PLACE FUTSAL OLIMPIADE FTSP 2013

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The facts stated in this Scholarship Form are true and complete to the best of my knowledge and belief.
I understand and agree to follow all the procedures, regulations, and requirements that related to Total E&P Indonesies Scholarship
Program.

Date:

Applicants Signature:

N.B: Please supply all of this documents, along with this form:
Copy of academic transcripts, from 1st semester until the last semester.

1 photo (3x4 cm).

Copy of the first page of your account book (that stated the Banks name, your name and account number).

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Date : APRIL 24, 2013

Name : INDRA PERKASA

1. Why are you entitled to accept this scholarship?

I deserve this scholarship because I have potential and competent in my academic and I have good time
management, I have experience in how to lead an organization. I have a strong desire to learn about oil from the
process of getting oil to process oil. I have some participant in the sector of petroleum engineering, such as I am
being a member of Society of Petroleum Engineering ITS SC and International SC. Then I have some experience
when I work practies in Pertamina EP, I enjoy working in the field of petroleum engineering, so I want to continue
my studies to the more spesific in petrolium engineering.
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2. Why do you want to continue your study to Master Degree?

I want to continue my study from bachelor degree to master degree because I want to expand my knowledge in
engineering focused to petroleum engineering and I want to be an expert of it, so can I learned much in petroleum
world, then I can working in leading oil and gas company. And also my reason to continue studying to master
degree to improve the standard when we getting a job. Because the salary standard of master degree is higher than
bachelor degree. And also to make it easier to get a job if I have a Master Degree. Another reason why I want to
continue my study to master degree because I want to expand my networking with people especially the experts.
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3. What is your plan after graduated from ITB Professional Masters in Petroleum Engineering?
My plan after I graduated from ITB then get Master degree in petroleum engineering is working in the oil and gas
company like Total E&P. Total E&P is oil and gas company based in French that pays high salaries to its
employees. Then in oil and gas company, I would connect my environmental science in bachelor degree with a
petroleum engineering to solve problems associated with petroleum world environmental also.
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