Registration of Prospective New Students for International Students

Biodata

Please provide accurate personal information as a prospective student. (*) Please fill in the fields marked with an asterisk.

Name *

Place of Birth *

Date of Birth *

Mother's Name *

Gender *

Religion *

Photo

File Size :
Uploaded Photo Description:

Formal Attire, with a red background
Photo file format: .jpg, .jpeg, or .png
Maximum file size: 500kb

Address

Please provide your residential address as a prospective student. (*) This field must be filled in.

ID Card / Passport Number (For Foreigners)

( Fill without punctuation )

Nationality *

Address

Fill without quotation mark (') or (")

Mobile Phone Number *

Email *

Education History

Please provide your Education History as a prospective student. (*) This field must be filled in.

Previous School *

Certificate Number

Date of Certificate *

Parent

Please accurately fill in the Parent information for the prospective student

Father's Biodata

Name

Date of Birth

Education

Occupation

Mother's Biodata

Name

Date of Birth

Education

Occupation

Wali

Silahkan mengisi data Wali calon Mahasiswa dengan benar

Nama

Tanggal Lahir

Pendidikan

Pekerjaan

Penghasilan

Program Study Choices

Please select the desired study program for the prospective student. The First Program Study should be the primary choice, and the Second Program Study as the secondary choice. (*) This field must be filled in.

Batch *

First Program Study *

Second Program Study

Enter Your Password

Enter a password of your choice for registering as a prospective student. The password must be at least 6 digits.

Password *

Repeat Password *

Please provide the source of information and enter the numbers located below for validation of the Registration form submission.

Source of Information

Captcha

Fill the numbers above

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PENDAFTARAN

Link

A - Tuna Netra	H - Hiperaktif
B - Tuna Rungu	I - Cerdas Istimewa
C - Tuna Grahita Ringan	J - Bakat Istimewa
C1 - Tuna Grahita Sedang	K - Kesulitan Belajar
D - Tuna Daksa Ringan	N - Narkoba
D1 - Tuna Daksa Sedang	O - Indigo
E - Tuna Laras	P - Down Syndrome
F - Tuna Wicara	Q - Autis

A - Tuna Netra	H - Hiperaktif
B - Tuna Rungu	I - Cerdas Istimewa
C - Tuna Grahita Ringan	J - Bakat Istimewa
C1 - Tuna Grahita Sedang	K - Kesulitan Belajar
D - Tuna Daksa Ringan	N - Narkoba
D1 - Tuna Daksa Sedang	O - Indigo
E - Tuna Laras	P - Down Syndrome
F - Tuna Wicara	Q - Autis

A - Tuna Netra	H - Hiperaktif
B - Tuna Rungu	I - Cerdas Istimewa
C - Tuna Grahita Ringan	J - Bakat Istimewa
C1 - Tuna Grahita Sedang	K - Kesulitan Belajar
D - Tuna Daksa Ringan	N - Narkoba
D1 - Tuna Daksa Sedang	O - Indigo
E - Tuna Laras	P - Down Syndrome
F - Tuna Wicara	Q - Autis