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SANTOS Petroleum Engineering Scholarship 2017

Australian Citizens or Permanent Residents Application Form

This application form should be used by Australian Citizens or Permanent Residents wishing to be considered for the SANTOS Petroleum Engineering Scholarships 2017.

Applicants must be entering University for the first time and be enrolling full-time in the single or combined-degree Bachelor of Engineering (Petroleum Engineering) program at the University of Adelaide.

This application form must be submitted online to the Australian School of Petroleum no later than Tuesday 24 January 2017, see end of form for details.

 Application Form
* Indicates Required Information

Personal Details

Indigenous Applicants

Indigenous applicants that are selected for interview will be asked to provide confirmation of their origins such as completion of a 'Confirmation of Aboriginality' form and having it endorsed by an Aboriginal and/or Torres Strait Islander community organisation.


Please list the subjects you undertook in Year 12, your ATAR/TER score and individual subject marks (include your raw score for all subjects)

Subject 1

Subject 2

Subject 3

Subject 4



Please give the name and contact information of your Maths and/or Physics teacher who may be contacted to act as a referee. Also, if you have worked in any leadership role please provide a relevant contact:

Physics Teacher

Maths Teacher



We have chosen the following provisional dates for interview, if selected for interview, please indicate your preferences for date and time.

NOTE: If you are selected for Interview and it is inconvenient for you to get to Adelaide (e.g. you live out-of-state or in “Country” SA, i.e. more than a few hours from Adelaide) we will make arrangements to interview you by telephone or preferably, by video call.



I declare that I have read the instructions on this application form and that, to the best of my knowledge, the information provided by me is true and complete. I acknowledge that the University of Adelaide may reverse any decision regarding award of a scholarship, on the basis of incorrect information supplied by me. I understand that I may be invited to attend a 20 minute interview conducted by a panel comprising of representatives from the Australian School of Petroleum at the University of Adelaide. I can be contacted at the address provided.


If you have any questions about your application, please contact Australian School of Petroleum on (08) 8313 8040 or email

Please submit the completed application form on line by close of business Tuesday 24 January 2017.

Australian School of Petroleum



T: +61 8 8313 8000
F: +61 8 8313 8030