530 Bush Street, Suite 1000

San Francisco, CA 94108 USA

Tel 415-362-6520
Fax 415-392-4667
www.iie.org Chevron@iie.org

CHEVRON CORPORATION
International REACH Scholarship Program
For Children of Company Employees

1ST ACADEMIC PROGRESS REPORT

DEADLINE: December 1, 2014
This is a required report for the information of IIE and your program sponsor.
It is not necessary that exams be completed prior to submission of this report.

Please complete sections A D of this form, and give it your academic advisor who should complete section E and return it to IIE. This document
may be mailed to the above address, emailed as a scanned attachment to chevron@iie.org or faxed to 415-392-4667.

A.

NAME:
CURRENT MAILING ADDRESS FOR RECEIVING CHECK:

(Please notify IIE if your mailing address changes. NOTE: Post office boxes are not permitted for express mail delivery.)

TELEPHONE NUMBER:
EMAIL ADDRESS (to be used for most correspondence):
SECONDARY (OR PARENTS) EMAIL ADDRESS:
ACADEMIC INSTITUTION:
FIELD OF STUDY:
DEGREE OR CERTIFICATE YOU ARE SEEKING:
ACADEMIC STANDING Year in Schhol (First Year, First Term, etc.):
ESTIMATED COMPLETION DATE OF YOUR DEGREE OR CERTIFICATE: (If there has been any change in your expected
completion date, please explain.)
Month: ____________ Year: _____________

NAME: ______________________
B.

DESCRIPTION OF YOUR STUDY PROGRAM

List all courses for which you are registered this term and plan to register for next term.
PRESENT TERM COURSES

NEXT TERM COURSES

Present Term End Date (month/year): ___/___ Next Term Start Date (month/year): ___/___
C.

STATUS OF YOUR PROGRAM

Number of Courses/Hours Required for Degree: _________
Number of Terms Required for Degree: ________________
TRANSCRIPT ATTACHED?

Number Completed: ______________

Number Completed: ______________

Yes No If no, date transcript will be sent to IIE: ____________

COMMENTS: You are requested to comment on your program, progress or problems below:

D.

SIGNATURE: ____________________________________________ DATE: ___________________

E.

TO BE COMPLETED BY YOUR ACADEMIC ADVISOR

After reviewing the information provided by the student above, please assist us in evaluating the students academic
performance so that we may consider his or her scholarship for renewal.
1) Is the student making satisfactory progress toward a degree or certificate?
Yes No (please explain):

2) Is the student's academic course load a full-time program of study?

Yes No (please explain):
3) Is the student's estimate of the time needed to complete the program accurate?
Yes No (please explain):
4) Are there any special problems affecting the student's study program?
No Yes (please explain):
5) Please provide any comments that may be useful in evaluating the students academic performance.

Name of Academic Advisor (please print):__________________________________________

TITLE: _________________________________ DEPARTMENT: ______________________
SIGNATURE: _________________________________________ DATE: _________________
EMAIL ADDRESS: _______________________TELEPHONE NUMBER: _________________
INSTITUTION WEBSITE (if available):_____________________________________________