MESSAGE FROM THE RECTOR
Dr. (Hon) Jonathan L. Parapak, M.Eng.Sc. Chancellor/Rector
Lippo Village, February 24th, 2015
Welcome to UPH Global Campus, Selamat datang di UPH Global Campus,
This Admission Manual Book has been prepared to provide you with comprehensive information regarding UPH Undergraduate Programs and enrollment procedures. Buku Petunjuk Pendaftaran ini dipersiapkan untuk memberikan informasi menyeluruh mengenai Program Sarjana Strata 1 dan prosedur penerimaan mahasiswa baru.
We are eager to have you in the UPH family and introduce you to the vision of our university, which is: True Knowledge, Faith in Christ, and Godly Character.
Kami ingin Anda dapat bergabung dengan kami dan memperkenalkan Anda tentang visi UPH, yaitu: True Knowledge, Faith in Christ, dan Godly Character.
UPH is committed to serve you in the best possible ways, by providing a holistic and internationally qualified education, and
world-class facilities, technology, and infrastructure. UPH also prepares students to be globally respected and appreciated by modern industries and businesses.
UPH berkomitmen memberi Anda pelayanan terbaik dengan menyediakan pendidikan holistik dengan kualitas internasional, fasilitas, teknologi serta infrastruktur kelas dunia.
UPH juga mempersiapkan mahasiswa agar dapat diakui secara global dan diapresisasi oleh industri dan bisnis modern. We welcome you to UPH Global Campus in Indonesia where learning is fun and excellent holistic education is open to you.
Selamat datang di UPH Global Campus, dimana kami menyediakan proses pembelajaran yang menyenangkan melalui pendidikan holistik terbaik di Indonesia.
I pray that God will richly bless you during your study at UPH. Saya berdoa agar Tuhan selalu memberkati Anda selama masa kuliah Anda di UPH.
TABLE OF CONTENT
Message from The Rector i
Table of Content ii
Online Admission Process 1
Important Notes 2
Admission & Scholarship Schedule 3
Undergraduate Program 4
Admission Requirements 5
Additional Requirements for Scholarship 6
Admission Test Regulations 7
Admission Statement 9
Scholarship Application Form 11
Art & Sport Scholarship Recommendation Form 12
Medical School Form 13
Health Declaration Form 14
Conservatory of Music Application Form 15
Conservatory of Music Recommendation Form 16
Full-English Class Application Form 17
ONLINE ADMISSION PROCESS
Re gist er Ac count Link: http:// online-admission.uph.edu Dir ect Admission Admission T est (Medic al School, Homeschooling & PKBM) Dir ect Admission Admission T est (Medic al School ONL Y) Int er vie w Selection Result Failed Re gular Admission Result Failed Scholar ship Result Passed Passed Passed Regular Admission Scholarship Admission O ffe rin g Le tt er Submit details & send
requir ed documents Fill applic ation de tails Online Applic ation P ayment Rec eiv e F orm Number UPH F estiv al Join UPH F estiv al as a Ne w st udent Payment Pr oc ess
Based on the off
ering le tt er Submit R e-R egistr ation F orm Comple te R e-r egistr ation F orm and submit t o AD AK Bur eau at building A, 3r d fl., July 1-31 August , 2016, 07.30 - 16.00 WIB Submit Unif orm Fitting F
orm & phot
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for UPH Smart
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E-mailed b
y bma@uph.
To complete application process please proceed the payment in accordance to Offering Letter. E-payment procedure is available on http://uph.edu/prospective-students.html.
Untuk menyelesaikan proses pendaftaran silahkan lakukan pembayaran sesuai dengan Offering Letter. Prosedur e-payment tersedia di http://uph.edu/prospective-students.html.
FORM NUMBER IS REQUIRED TO PROCEED THE PAYMENT.
PLEASE FIND YOUR FORM NUMBER IN YOUR OFFERING LETTER. NOMOR FORMULIR DIBUTUHKAN UNTUK MELAKUKAN PEMBAYARAN. NOMOR FORMULIR DAPAT DITEMUKAN DALAM OFFERING LETTER ANDA.
FORM NUMBER NOMOR FORMULIR
IMPORTANT NOTES
Application will be processed if the data and documents have met the requirements and been accepted by UPH.
Aplikasi akan diproses apabila data dan dokumen sudah diterima lengkap oleh UPH.
Completed application will be processed within 14 working days.
Aplikasi yang sudah lengkap akan diproses dalam jangka waktu 14 hari kerja.
Admission result will be announced by 2 (two) methods:
Hasil akan diumumkan melalui 2(dua) metode:
Offering Letter posted on Online Admission Website
1. Login to the following link: http://online-admission.uph.edu
2. Choose Admission Result to see OFFERING LETTER
Offering Letter ditampilkan di website pendaftaran online 1. Login ke link berikut ini: http://online-admission.uph.edu 2. Pilih hasil pendaftaran untuk melihat OFFERING LETTER
Offering Letter sent to applicant’s address. Offering Letter dikirimkan ke alamat calon mahasiswa
1
STMETHOD | METODE 1
2
NDMETHOD | METODE 2
If you need more detailed information, please contact us through:
Apabila anda memerlukan informasi yang lebih detail, dapat menghubungi kami melalui: UPH GLOBAL CAMPUS
Jl. M.H. Thamrin Boulevard 1100 Lippo Village Tangerang 15811 – Indonesia (021) 5470901 (021) 5460910 undergraduate.admission@uph.edu
ADMISSION & SCHOLARSHIP SCHEDULE
Schedule may be subject to change, latest info please check www.uph.edu Early Admission 1 Early Admission 2 Outside Jabodetabek Term 1 Term 2 Term 3 Term 4 23 SEPT 2015 13 NOV 2015 13 NOV 2015 15 JAN 2016 04 MAR 2016 29 APR 2016 01 JUL 2016 10 OCT 2015 28 NOV 2015 28 NOV 2015 30 JAN 2016 19 MAR 2016 13 MAY 2016 15 JUL 2016
SUBMISSION DEADLINE ADMISSION TEST
Best Student Term 1 Term 2 Term 1 Term 2 28 AUG 2015 11 SEPT 2015 30 0CT 2015 28 AUG 2015 15 JAN 2016 31 AUG - 11 SEPT 2015 14 SEPT - 02 OCT 2015 02 - 13 NOV 2015 TBA TBA
SUBMISSION DEADLINE INTERVIEW SESSION
-05 SEPT 2015 30 JAN 2016 ADMISSION TEST 28 SEPT 2015 19 OCT 2015 30 NOV 2015 12 OCT 2015 14 MAR 2016 ANNOUNCEMENT ADMISSION SCHEDULE 2016/2017 SCHOLARSHIP SCHEDULE 2016/2017 Early Admission 1 Early Admission 2 Outside Jabodetabek Term 1 Term 3 07 OCT 2015 25 NOV 2015 25 NOV 2015 27 JAN 2016 10 MAY 2016 10 OCT 2015 28 NOV 2015 28 NOV 2015 30 JAN 2016 13 MAY 2016
SUBMISSION DEADLINE ADMISSION TEST
ALL MAJORS EXCEPT MEDICINE
MEDICINE
ALL MAJORS EXCEPT MEDICINE
MEDICINE
1. Double Degree and Dual Degree Programmes are listed based on information by May 2015.
2. Prospective Students are not required to choose Double Degree or Dual Degree in the first year. These programmes are subject to rules and regulations applied. 3. Prospective Students must decide and choose Joint Degree from the first term and complete 2 (two) application package (UPH & RMIT Application).
UNDERGRADUATE PROGRAM
* Available also in Online Learning *** Only for English Education ** For admission requirements and further information, please call :
• Faculty of Nursing : (021) 546 0901 ext. 3437 • Teachers College : (021) 546 6057 ext. 2613/2637
ü
--
-Biology Education, Economics
Education, English Education, Mathematics Education, Primary Education -ü*** HIGH SCHOOL MAJOR ü Management Accounting Medicine Applied Communication Sciences* Political Science Law Architecture
Visual Communication Design
Interior Design Applied Mathematics Biotechnology Electrical Engineering Industrial Engineering Civil Engineering Food Technology Information System Informatics Computer Technology Psychology Music Hospitality Management Travel Industry Management
Philosophy Government and Global Affairs Product Design ü ü ü -ü - -- -ü - -- -- -- -- -- -- -ü ü -- -- -- -Nursing -ü ü
-FACULTY MAJOR FULL ENGLISH CLASS DOUBLEDEGREE DUAL/JOINTDEGREE
--
-IPA & IPS
IPA IPA
IPA IPA
IPA IPA & IPS IPA & IPS IPA & IPS IPA & IPS IPA & IPS IPA & IPS IPA & IPS IPA & IPS IPA & IPS IPA & IPS
IPA & IPS IPA & IPS
IPA & IPS IPA & IPS IPA & IPS
IPA & IPS
IPA & IPS IPA & IPS IPA & IPS IPA & IPS IPA
Faculty of Education -Teachers College**
Business School
Faculty of Social and Political
Sciences
School of Law
School of Design
Faculty of Science and Technology Faculty of Computer Science Faculty of Psychology Conservatory of Music Medical School School of Hospitality and Tourism School of Philosophy & Divinity Faculty of Nursing and Apllied
Health Sciences** Computer Technology Applied Mathematics Information Systems Informatics Management Accounting Applied Mathematics Management
A copy of valid ID Card (KTP/Kartu Pelajar/SIM/Passport) ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü
ADMISSION REQUIREMENTS
DOCUMENTSNO CurriculumNational O LevelIGCSE A/AS LevelIGCSE Others
Admission Statement (see page 9)
A copy of TOEFL IBT /IELTS Certificate with minimum score 61 for TOEFL IBT or 5.5 for IELTS (only for non Indonesian passport Holder/WNA)
A legalized copy of Academic Records : Grade 10 and 11 Full-English Classes Application Form (see page 17) Stamp duty Rp.6000,- (put on Admission Statement page 9)
A legalized copy of O Level/A Level/AS Level IGCSE Report/Certificate (min 5 subject)
A legalized copy of IB Predicted 1 2 3 4 5 6 7 8 9 International Baccalaureate COMPULSORY REQUIREMENTS FOR ALL MAJORS
A legalized copy of Junior High School National Examination/UN SMP ü ü ü ü ü
DOCUMENTS NO
Conservatory of Music Application Form & Conservatory of Music Recommendation Form (see page 17-18) 1 (one) video audition in WMA/MP4/AVI format for each concentration
For procedure and audition requirements (include sample of Theory and Solfeggio Exam), please see http://music.uph.edu/admission/procedure.html 1
2 3
A 500 word English Essay about “Why I am Interested in Medicine and How I Will Use It to Provide Good Health Care for the People of Indonesia in the Future.”
DOCUMENTS NO
Medical School Application Form & Health Declaration Form (see page 15-16) Color Blindness Test Certificate by Ophthalmologist / Oculist
1 2 3
ADDITIONAL REQUIREMENTS FOR SCHOOL OF DESIGN
DOCUMENTS NO
One page Essay: “Why I Choose X Major Study Program” Color Blindness Test Certificate by Ophthalmologist/Oculist
Architecture: 3 (three) hand drawings/portfolios with Drawing Theme: Free, Interior, and Exterior DKV: 3 (three) hand drawings/portfolios with Media of Portfolio: Pencil, Paint, and Free Media Product Design: 2 hand drawings with Media: A3-size Paper & Pencil.
• Industry Based Design (gadget, home appliances, automotive, furniture, stationary, etc)
• Handicraft based design (jewelry, furniture, etc). Both preferably an innovation, complete with the uniqueness explanation. 1
2 3 4 5
Interior Design: For portfolio requirements, please see interior.sod.uph.edu 6
ADDITIONAL REQUIREMENTS FOR CONSERVATORY OF MUSIC
ADDITIONAL REQUIREMENTS FOR MEDICAL SCHOOL
2 Recent Photo size 3x4 using white collared shirt with blue background 4
DOCUMENTS NO
Psychology Program Application Form (see page 19) 1
Academic Achievement Category Limited Financial Category Art Achievement Category Sport Achievement Category
Scholarship Application Form (see page 11)
Copy of Family Card/Kartu Keluarga
A-500-word English Essay about:
“Why I Choose X Major at UPH as a Stepping Stone for My Career” (Except School of Design and Faculty of Medicine)
Copy of achievement certificate in any fields
A statement letter of family financial condition, issued by: Church (for Christian/Catholic) or RT/RW/Kelurahan (for other religions)
ADDITIONAL REQUIREMENTS
FOR SCHOLARSHIP
DOCUMENTS NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14Copy of electricity bill for the last 3 months
Copy of water bill for the last 3 months
Copy of landline telephone bill for the last 3 months
Copy of the last Pajak Bumi dan Bangunan (PBB) payment
Copy of Parent’s payslip of income
Art & Sport Scholarship Recommendation Form (see page 12)
Recent photo (postcard size) using team uniform (write your name, height and weight behind the photo)
Copy of sports certificate of performance (province/national/international level)
Recommendation Letter from Komite Olahraga National Indonesia (KONI)
ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü ü COMPULSORY REQUIREMENTS FOR ALL MAJORS
ADMISSION TEST REGULATIONS
BEFORE THE TEST1. Participant is required to wear proper attire and shoes.
2. Participant is required to bring their own stationery (pen, 2B pencil, eraser, and calculator), Admission Test Participant Card and original ID card (KTP, driving license or other identification which has photograph of participant). Participant who does not bring the requirements must report to the Admission Test Committee.
3. Participant must be present in the test room 30 minutes before the test begin. Participant who is late is allowed to participate in the test without additional time.
SEBELUM UJIAN BERLANGSUNG
1. Peserta wajib berpakaian rapi, sopan, dan bersepatu tertutup.
2. Peserta wajib membawa alat tulis (pena, pensil 2B, penghapus, dan kalkulator) milik sendiri, Kartu Tanda Peserta Ujian Saringan Masuk, dan kartu identitas asli (KTP, SIM atau identitas lainnya yang memuat pasfoto peserta). Peserta yang tidak membawa perlengkapan tersebut, wajib melapor kepada panitia Ujian Saringan Masuk.
3. Peserta wajib berada di ruang ujian 30 menit sebelum ujian dimulai. Peserta yang terlambat diperbolehkan mengikuti ujian tanpa ada penambahan waktu.
DURING THE TEST
1. Participant is prohibited to interact with other participants.
2. Participant is not allowed to leave the test room without permission from the supervisor. 3. Participant should stop doing the test when there is a time up notification.
4. Breaking the Admission Test Regulations will cause participants a disqualification from the test and cancellation on the registration process.
SELAMA UJIAN BERLANGSUNG
1. Peserta dilarang berinteraksi dengan peserta lain.
2. Peserta dilarang meninggalkan tempat ujian tanpa izin dari pengawas.
3. Peserta wajib menghentikan pekerjaannya setelah ada pemberitahuan bahwa waktu ujian telah berakhir.
4. Peserta akan dianggap gugur dan dibatalkan proses pendaftarannya jika melanggar tata tertib Ujian Saringan Masuk. IMPORTANT
Participants must not cheat during the Admission Test under any conditions. If UPH finds out later that the participant has cheated on the test, then the participant will be terminated from UPH and no fees will be refunded.
PENTING
Peserta dilarang melakukan kecurangan saat Ujian Saringan Masuk. Apabila di kemudian hari diketahui bahwa mahasiswa aktif telah melakukan kecurangan saat ujian, mahasiswa yang bersangkutan akan dikeluarkan dari UPH tanpa ada pengembalian biaya kuliah yang telah dibayarkan.
pot
ong disini
I, the undersigned:
Saya yang bertanda tangan di bawah ini:
Form Number :
Nomor Formulir
Full Name :
Nama Lengkap
Hereby affirm that,
dengan ini menegaskan bahwa,
1. I understand that the education program of UPH/STPPH is characterized by the Christian Faith, based on the Pancasila and UUD 1945.
Mengetahui bahwa penyelenggaraan pendidikan di UPH/STPPH bercirikan iman Kristiani dan berdasarkan Pancasila dan UUD 1945
2. I will not engage in any conduct against the law; bring, consume, and/or distribute illegal drugs or alcoholic drinks.
The right to be a student of UPH/STPPH will be denied should I fail the health examination/drug examination at any given time by UPH/STPPH. Tidak akan melakukan semua perbuatan yang melanggar hukum; membawa, mengkonsumsi serta mengedarkan obat terlarang
(Narkoba)/minuman keras. Hak sebagai mahasiswa UPH/STPPH akan gugur bila tidak lulus dalam tes kesehatan/tes narkoba yang waktu akan dilakukan oleh pihak UPH/STPPH.
3. I am willing to participate in a blood/urine examination at any given time by UPH/STTPH. Bersedia melakukan tes darah/urine yang sewaktu-waktu akan dilakukan oleh pihak UPH/STTPH.
4. All documents that I submit are legal. I am fully responsible for any consequences and willing to accept all sanctions for any INCORRECT information.
Semua dokumen yang dikumpulkan ke UPH adalah sah. Saya bersedia menanggung segala sanksi apabila informasi yang saya berikan TIDAK BENAR.
5. I am willing to accept sanctions (Drop Out) from UPH/STPPH unless I can submit the copy of High School Certificate or High School Certificate Equivalency before the end of 2nd term, even though the tuition fee has been paid.
Bersedia menanggung sanksi (dikeluarkan) dari UPH/STPPH jika tidak dapat menyerahkan fotokopi ijazah SMA Nasional/Surat Penyetaraan
Ijazah sebelum term 2 berakhir walaupun sudah diterima dan membayar uang kuliah.
6. For Faculty of Psychology: I acknowledge and agree to follow the curriculum in Faculty of Psychology that is enriched with Christian values.
I am fully aware that there will be individual counseling as a prerequisite to continue study in the next terms (2nd term).
Untuk Fakultas Psikologi: Saya mengetahui dan menyetujui untuk mengikuti pembelajaran di Fakultas Psikologi UPH yang diperkaya dengan
nilai-nilai Kristiani. Saya menyadari sepenuhnya bahwa akan ada konseling pribadi sebagai prasyarat untuk melanjutkan pembelajaran pada term berikutnya (term 2).
7. I understand that Double Degree and Dual Degree programmes will start after the first year of class. These programmes are subject to the applied rules and regulations .
Saya mengerti bahwa program Double Degree dan Dual Degree akan dilaksanakan setelah tahun pertama perkuliahan, sehingga akan ada
kemungkinan terjadi perubahan.
8. I understand that if the quota of a class is full, UPH has the right not to accept any payment although it is before payment deadline. Saya mengerti bahwa jika batas maksimum kapasitas jumlah mahasiswa yang dapat diterima sudah tercapai, maka UPH berhak menolak
pembayaran yang akan dilakukan meskipun belum mencapai batas akhir pembayaran.
9. All payments transferred to Pelita Harapan Foundation are declared as the final decision, finalized by the depositor, can’t be refunded for any conditions.
Semua pembayaran yang telah disetor ke Yayasan Universitas Pelita Harapan dinyatakan sebagai keputusan akhir dari pihak penyetor
dan tidak dapat ditarik kembali dengan alasan dan kondisi apapun.
10. I along with my parents hereby acknowledged and confirmed our acceptance on the consequences of provisions number 9 as stated above and therefore we will not file any law suit in connection with provision number 9 above.
Saya bersama dengan orang tua saya dengan ini menegaskan bahwa kami sudah mengerti dan menerima konsekuensi dari ketentuan point
9 di atas dan oleh karena itu kami tidak akan mengajukan gugatan hukum apapun di kemudian hari sehubungan dengan ketentuan nomor 9 tersebut di atas.
11. All documents that I submit fully belong to UPH and UPH will not entertain requests to return the documents for any reason. Semua dokumen yang dikumpulkan sepenuhnya menjadi milik UPH dan tidak dapat dikembalikan dengan alasan apapun. 12. I agree to abide by the Regulations stated by the University, both now and in the future.
Bersedia mentaati Statuta, Peraturan Tata Tertib Kampus, dan peraturan lain yang telah dan akan diberlakukan.
13. I have read, known, and understood the regulations and registration requirements stated in this Admission Manual. Telah membaca, mengetahui, mengerti ketentuan dan persyaratan pendaftaran dalam Buku Petunjuk Admisi ini.
ADMISSION STATEMENT
Copy 1 : Admission Office
Place | Tempat Date | Tanggal
PARENT/GUARDIAN’S SIGNATURE & FULL NAME
Tanda Tangan & Nama Lengkap Orang Tua/Wali PROSPECTIVE STUDENT’S SIGNATURE & FULL NAMETanda Tangan & Nama Lengkap Calon Mahasiswa READ CAREFULLY BEFORE YOU SIGN!
Bacalah dengan seksama sebelum Anda menandatangani!
Stamp Duty/Materai Rp. 6000 Please sign on the stamp duty/
Harap tanda tangan di atas materai
pot
ong disini
I, the undersigned:
Saya yang bertanda tangan di bawah ini: Form Number :
Nomor Formulir Full Name : Nama Lengkap
I certify that the above information is true and correct. Saya tegaskan informasi di atas adalah benar.
SCHOLARSHIP APPLICATION FORM
Social, Organizational or Leadership Activities Aktivitas sosial, organisasi atau kepimpinan
Achievements (Senior High School Level)
Penghargaan yang pernah diperoleh (di tingkat SMA)
(Please attach certificate that support this information)
(Lampirkan fotokopi sertifikat sebagai bukti yang mendukung informasi ini)
Student Council Spiritual Activities
Martial Arts Scout
Flag-raising Squad Others,
Red Cross Youth Council Sport
Choir/Vocal Group Band/Orchestra Language Club
Religious Activities at Church Aktivitas keagamaan di gereja
If you are Christian/Catholic, please fill the following information: Jika Anda beragama Kristen/Katolik, harap isi keterangan berikut ini: Church :
Nama Gereja
Address : Alamat Gereja
Join ministry/activities : Mengikuti kegiatan pelayanan
Academic Achievement | Prestasi Akademik Art Achievement | Prestasi Seni Limited Finance | Kondisi Ekonomi Terbatas Sport Achievement | Prestasi Olahraga SCHOLARSHIP APPLICATION FOR ALL CATEGORIES
Place | Tempat Date | Tanggal
PARENT/GUARDIAN’S SIGNATURE & FULL NAME ,
I, the undersigned:
Saya yang bertanda tangan di bawah ini: Coach/Teacher Full Name : Nama lengkap Pelatih/Guru High School/Institution Name : Nama Sekolah/Institusi
Please recommend this prospective student regarding his/her scholarship application: Mohon untuk merekomendasikan Calon Mahasiswa ini pada pendaftaran Program Beasiswa: Form Number :
Nomor Formulir Full Name : Nama Lengkap
Height : cm Weight : kg Tinggi Badan Berat Badan
Position in Team : 1. __________________________ 2. __________________________ 3. __________________________ Posisi pada Tim
I certify that the above information is true and correct. Saya tegaskan informasi diatas adalah benar.
Coach/Teacher, Pelatih/Guru
ART & SPORT SCHOLARSHIP
RECOMMENDATION FORM
Coach/Teacher of: Pelatih/Guru Coach Pelatih Guitar Bass KeyboardBasketball Volleyball Soccer Swimming Badminton
Drum Piano Choir Modern Dance Vocal Traditional Dance Acting Photography Video Editing
Place | Tempat Date | Tanggal
Coach/Teacher’s Signature & Full Name + Stamp (if any) Tanda Tangan & Nama Lengkap Pelatih/Guru + Cap (jika ada)
SCHOLARSHIP APPLICATION FOR ART ACHIEVEMENT OR SPORT ACHIEVEMENT CATEGORY
SPORT ART
Futsal
MEDICAL SCHOOL FORM
pot ong disini Form Number : Nomor Formulir Full Name : Nama LengkapPlace & Date of Birth : Tempat & Tanggal Lahir Name of Parent : Nama Orang Tua
Name of Family Doctor : Nama Dokter Keluarga
Prospective Student, Calon Mahasiswa
Please provide a brief summary of all volunteering, caring, community leadership, religious services and organizations that you have participated in.
Jelaskan secara singkat semua bentuk partisipasi Anda pada kegiatan relawan, kepemimpinan, pelayanan keagamaan dan organisasi.
Please provide a brief summary of your current sports, artistic activities, hobbies, and interests.
Jelaskan secara singkat tentang kegiatan olahraga, seni, hobi, dan minat Anda saat ini.
Prospective Student’s Signature & Full Name Tanda Tangan & Nama Lengkap Calon Mahasiswa
PROSPECTIVE STUDENT
COMMUNITY INVOLVEMENT
PERSONAL ACHIEVEMENT
Place | Tempat Date | Tanggal ,
HEALTH DECLARATION FORM
If you are accepted as a student of the Medical School, you will be required to complete the “Health Declaration Form” prior to joining for your classes. The information provided to us is confidential and will not be used for any other purposes except providing support for the student.
Jika Anda diterima sebagai mahasiswa Fakultas Kedokteran, Anda wajib melengkapi “Formulir Pernyataan Kesehatan” sebelum bergabung di dalam kelas. Informasi yang diberikan kepada kami bersifat rahasia dan tidak akan digunakan untuk tujuan lain kecuali memberikan dukungan bagi siswa.
I, the undersigned:
Saya yang bertanda tangan di bawah ini: Full Name :
Nama Lengkap
No. HEALTH DECLARATIONPernyataan YESYa TidakNO KeteranganDETAILS
1 Do you have, or have you ever had, any medical conditions or operations in the past 5 years?Apakah Anda memiliki atau pernah memiliki kondisi medis tertentu atau pernah menjalani operasi dalam 5 tahun terakhir? 2 Are you at present attending a doctor for medical care, taking any medication or on a waiting list for hospital assessment or treatment?
Apakah Anda saat ini sedang akan menjalani perawatan medis, mengkonsumsi obat-obatan? 3
Do you have impairment/disability (physical or metal) or specific learning disability which may affect your ability to study in UPH Medical School?
Apakah Anda memilki kekurangan/cacat (fisik atau mental) atau ketidakmampuan belajar yang dapat mempengaruhi proses belajar Anda di Fakultas Kedokteran UPH?
4 Have you ever suffered from tuberculosis (TB) within the past 12 months?Apakah Anda pernah menderita tuberkulosis (TB) dalam 12 bulan terakhir?
5 Has any family member or close contact been treated for TB?Apakah ada anggota keluarga atau orang di sekitar Anda yang pernah dirawat karena TBC? 6 Have you had a cough for more than 3 weeks?Apakah Anda menderita batuk lebih dari 3 minggu?
7 Have you coughed up blood?Apakah Anda pernah batuk berdarah?
8 Have you had any unexplained weight loss?Apakah Anda pernah kehilangan berat badan tanpa sebab yang dapat dijelaskan? 9 Have you suffered from night sweats or fever?Apakah Anda menderita demam atau keringat berlebih saat tidur?
10 Have you ever had any kind of back, joint or muscle problem?Apakah Anda mengalami sakit punggung, sendi atau masalah otot?
11 Have you ever had, Dermatitis, Eczema, Psoriasis or any other skin condition?Apakah Anda pernah mengalami: Dermatitis, Eksim, Psoriasis atau penyakit kulit lainnya? 12
Have you ever had any mental illness which might affect your ability to study and practice medical science? (including anxiety, depression, self-harm, eating disorders, psychological or emotional problems)
Pernahkah Anda punya penyakit mental yang berpotensi mempengaruhi kemampuan Anda dalam belajar dan mempraktekkan ilmu medis?
13 Have you ever had a drug, tobacco, nicotine or alcohol problem?Apakah Anda pernah memiliki masalah yang terkait dengan narkoba, tembakau, nikotin atau alkohol? 14 Do you have any difficulty with your eyesight, including color blindess?Apakah Anda memiliki kesulitan dengan penglihatan Anda, termasuk buta warna?
15 Do you have difficulty in hearing?Apakah Anda memiliki kesulitan pendengaran?
16 Have you ever suffered from any of the following: loss of consciousness including fainting attacks, blackouts or epilepsy?Pernahkah Anda menderita kehilangan kesadaran termasuk pingsan atau pingsan karena epilepsi 17 Have you ever suffered from any of the following: heart disease, diabetes, Hypertension or any other medical illness?Pernahkah Anda pernah mengalami; penyakit jantung, diabetes, Hipertensi atau penyakit medis lainnya? 18 Have you ever suffered from chest or lung problems: Asthma, Bronchitis?Apakah Anda pernah mengalami masalah paru-paru: Asma, atau Bronkitis?
19 Have you ever had any allergies, including to drugs, food or latex?Pernahkah Anda punya alergi, termasuk alergi terhadap obat-obatan, makanan atau lateks? 20 Have you ever received treatment for bowel or gastric problems?Apakah Anda menerima perawatan karena masalah usus atau lambung?
21 Do you have any other medical conditions not previously mentioned in questions 1 – 15 above?Apakah Anda pernah mengalami masalah kesehatan lainnya yang tidak disebutkan pada pertanyaan 1 – 15? 22 Have you been vaccinated for Hepatitis? If you have, what was the dosage?Apakah Anda pernah mendapat vaksin Hepatitis? Jika ya, berapa dosisnya?
23
Have you had any episode of Jaundice/Hepatitis? If yes, please submit the Laboratory Blood Report. If you already committed, you have to submit the Laboratory Blood Report to FK Admission Office, FK Building 2nd fl, on August 1-10, 2016 during weekdays. Apakah Anda pernah menderita Hepatitis? Jika ya, harap mengirimkan Hasil Periksa Darah dari laboratorium ke kantor Administrasi FK, Gedung FK lt.2, pada tanggal 1-10 Agustus 2016 di hari kerja.
I certify that the above information is true and correct.
Saya tegaskan informasi diatas adalah benar.
Place | Tempat Date | Tanggal Signature & Full Name Tanda Tangan & Nama Lengkap
Medical School New Student,
NOTES
1. Complete the Student Information form.
2. Check the admission requirement and procedure at www.music.uph.edu
3. Applicants for all concentrations have to submit a good quality DVD/VCD recording which contains three contrasting pieces. 4. Applicants may be asked to take a Music Placement Test (Music Theory and Solfeggio).
5. The Recommendation form (p.16) must be completed by the referee.
CONSERVATORY OF MUSIC
APPLICATION FORM
pot ong disini Form Number : Nomor Formulir Full Name : Nama LengkapHigh School Name : Nama Sekolah
Preferred Consentration (Put Rank 1st, 2nd, and 3rd based on priority)
Konsentrasi Pilihan (Pilih berdasarkan prioritas 1, 2, dan 3) Preferred major instrument: (Please tick one only)Instrumen Pilihan: (Pilih salah satu)
Arts Management Jazz and Pop Performance
Church Music Music Education
Classical Performance Music Therapy
Composition Sound Design
Why did you choose UPH Conservatory of Music? Describe.
Mengapa Anda memilih Conservatory of Music UPH? Jelaskan. How does music impact your life?Bagaimana musik memberi dampak bagi hidup Anda?
Why did you choose your 1st choice consentration?
Mengapa Anda memilih pilihan konsentrasi pertama? Who is your favorite composer or performer? Why?Siapa komposer/performer favorit Anda? Mengapa?
Ensemble playing experience: Yes/No
Apakah Anda pernah memainkan ensemble: Ya/Tidak
Did you apply to a Conservatory of Music other than UPH? Yes/No
Apakah Anda mendaftar ke jurusan Musik selain di UPH? Ya/Tidak
Recent teacher name: _______________________________ Institution/music schools: ___________________________ Music award ever received (if any): ____________________
Why did you choose your 2nd choice consentration?
Mengapa Anda memilih pilihan konsentrasi kedua?
Why did you choose your 3rd choice consentration?
Mengapa Anda memilih pilihan konsentrasi ketiga?
Mention the repertoire that you have learned!
Sebutkan repertoire yang pernah Anda pelajari!
Briefly, describe your goals and what influence you to plan a career in music.
Jelaskan secara singkat mengenai tujuan dan dampak yang Anda dapat berikan saat berkarir di bidang musik. Classical Instrument Piano Vocal Guitar Violin Viola Cello Contra-Bass Flute Clarinet Bassoon French-Horn Trumpet Trombone Tuba Percussion Harp Oboe Non-classical Instrument Piano Vocal Electric Guitar Electric Bass Drum Saxophone
Full Name : Nama Lengkap
Institution/School of Music : Nama Sekolah Musik
Phone Number : Nomor Telepon
Mobile Phone : Nomor Handphone
Length of Courses : Year Frequency/week : Hours/Course : Lama Belajar Tahun Frekuensi/minggu Jam/Kelas Please circle the most appropriate answer based on prospective student’s music skill.
Silahkan lingkari pilihan yang sesuai dengan opini Anda mengenai keterampilan musik Calon Mahasiswa berdasarkan keterampilan musik calon mahasiswa
I certify that the above information is true and correct. Saya tegaskan informasi diatas adalah benar.
Referee’s Signature & Full Name + Stamp (if any)
Tanda Tangan & Nama Lengkap Pemberi Rekomendasi + Cap (jika ada) Place | Tempat Date | Tanggal
,
REFEREE | PEMBERI REKOMENDASI
CONSERVATORY OF MUSIC
RECOMMENDATION FORM
1. Technical strength in playing the instrument: a. Solid
b. Need supervision to be solid c. Difficult to be solid
2. Musical strength in playing the instrument:
a. Sensitive and able to perform an outstanding musical showing diligence to do the work
b. sensitive yet need guidance c. less sensitive
3. Knowledge of Theory of Music
a. Very Good in making harmony using S-A-T-B format b. Know basic format in writing S-A-T-B
c. Doesn’t have a deep knowledge in theory of music 4. Knowledge about aural training
a. Well trained in soffegio/prima vista for example: ritmic dictation, melody, interval, and harmony b. Has sufficient session in aural training but only before the examination period.
c. Haven’t received aural training yet 5. Knowledge about history of music
a. Has interest in learning the history of music as well as background of songs that he/she is playing b. Has sufficient guidance
c. Never received any guidance
6. Level of diligence
a. Show a great enthusiasm to learn his/her musical pieces b. Has ambition to develop his/her musical ability yet less consistent c. Depends on mood, always need support to gain motivation and inspiration 7. Level of speed to grasp knowledge
a. Shows rapid development in a short amount of time
b. Not too fast in showing diligence to do the work ability by his/her own intitative c. Not too fast and less careful over the given correction not too fast and less careful over the given correction
8. Your opinion about the maturity of your student a. Mature
b. Quite mature c. Immature
9. Level of confidence to see your student will be able to succeed studying at UPH Conservatory of Music with his/her chosen rhythmic dictation, melody, interval, and harmony concentration
a. Very sure 80%-100% b. Sure 60%-80% c. Unsure 50%-60%
10. Your consideration for the student to get scholarship a. Highly recommended
b. Recommended c. Less recommended
REFEREE COMMENTS REGARDING SCHOLARSHIP APPLICANT | KOMENTAR PEMBERI REKOMENDASI MENGENAI PEMOHON
Referee,
Form Number :
Full Name :
Major :
Phone Number :
E-mail Address :
I will submit TOEFL/IELTS score by:
Take TOEFL Test at UPH Language Center. Please check the update schedule at www.uph.edu (Info Center). Submit a copy of TOEFL/IELTS Certificate (Submission deadline: June 26, 2015)
* we accept only TOEFL/IELTS results from LIA, AMINEF, TOEFL/IELTS International
1. This form is required ONLY for Prospective Student who apply to the available Full English Class as listed below: - Management - Accounting - Communication - International Relation - Law - Food Technology - Hospitality Management
2. Prospective Students must submit a copy of valid certificate of TOEFL/IELTS. 3. The minimum score to apply Full English Class:
TOEFL Paper Based Test : 500 TOEFL Internet Based Test : 59 – 60 IELTS : 5.0
If the requirement above can not be fulfilled, the Prospective Students could not apply Full English Class.
4. Full English Class has limited seats. All applications will be processed and selected by UPH. The Final decision could be ACCEPTED or NOT, and is an absolute decision.
____________, __________________ Place Date
( ___________________________________ ) Prospective Student’s Signature & Full Name
FULL-ENGLISH CLASSES
APPLICATION FORM
pot ong disini Mobile Number : Received by, ( ___________________________________ ) Admission Staff’s Signature & Full NameVerified by,
( ___________________________________ ) UPH Language Center’s Signature & Full Name PROSPECTIVE STUDENT WHO APPLY TO FULL ENGLISH CLASS IS REQUIRED TO FILL THIS FORM
UPH Admission Manual • Academic Year 2015/2016 16
PSYCHOLOGY PROGRAM
APPLICATION FORM
pot
ong disini
I, the undersigned:
Saya yang bertanda tangan di bawah ini:
Form Number : Nomor Formulir Full Name : Nama Lengkap Phone/Mobile Number : Nomor Telepon E-mail address : Alamat E-mail
I certify that the above information is true and correct. Saya tegaskan informasi diatas adalah benar.
PSYCHOLOGY PROGRAM
Psychology | Psikologi
Psychology & Entreprenurship | Psikologi & Kewirausahaan
Preferred Concentration | Konsentrasi Pilihan Please give tick (v) in your option | Silahkan berikan tanda (v) dalam pilihan Anda
Prospective Student’s Signature & Full Name Tanda Tangan & Nama Lengkap Calon Mahasiswa Place | Tempat Date | Tanggal
,
Parent/Guardian’s Signature & Full Name Tanda Tangan & Nama Lengkap Orang Tua/Wali
