Beasiswa S1 Kedokteran - Semua Jurusan di Universitas Pelita Harapan | INDBeasiswa

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MESSAGE

FROM

THE RECTOR

Selamat datang di UPH Global Campus,

Buku Petunjuk Pendaftaran ini dipersiapkan untuk memberikan informasi menyeluruh mengenai Program Sarjana Strata 1 dan prosedur penerimaan mahasiswa baru.

Kami menyambut Anda sebagai bagian dari Keluarga UPH dan memperkenalkan Anda tentang visi UPH, yaitu: Pengetahuan Sejati, Iman Dalam Kristus, dan Karakter Ilahi.

UPH berkomitmen memberi Anda pelayanan terbaik dengan menyediakan pendidikan holistis berkualitas internasional, didukung fasilitas, teknologi serta infrastruktur kelas dunia.

UPH juga mempersiapkan mahasiswa agar dapat diakui secara global dan diapresisasi oleh industri dan bisnis modern.

Selamat datang di UPH Global Campus, dimana kami menyediakan proses pembelajaran yang dinamis melalui Welcome to UPH Global Campus,

This Admission Manual has been prepared to

provide you with comprehensive information regarding

UPH Undergraduate Programs and enrollment procedures.

We welcome you to the UPH family and would like to introduce

you to the vision of our university: True Knowledge, Faith in

Christ, and Godly Character.

UPH is committed to serving you in the best possible ways, by

providing holistic and internationally recognized education,

world-class facilities, technology, and infrastructure. UPH also prepares

students to be globally informed and appreciated by multi-national

industries and businesses.

We welcome you to the UPH Global Campus in Indonesia

where learning is dinamic within an excellent holistic

Dr. (Hon) Jonathan L. Parapak, M.Eng.Sc Chancellor / Rector

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Admission Process

Payment Process Based on the offering letter

Submit Re-Registration Form Complete Re-registration Form (Page 27-28) and submit to Submit Uniform Fitting Form & photo for UPH Smartcard e-mailed by bma@uph.edu

Submit Application

Form

Direct Admission

Admission Test

(Medicine, Homeschooling & PKBM)

Interview Selection

Result Failed Failed

Failed

(Failed Scholarship, Accepted Reguler) Scholarship

Result Passed

Passed Passed

Regular Admission Scholarship

Admission

Offering Letter Admission Test

(Medicine ONLY)

Regular Admission

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Important Notes

Application will be processed if the form and documents have met the requirements and been accepted by UPH.

Formulir akan diproses apabila formulir dan dokumen sudah diterima lengkap oleh UPH.

Completed form will be processed within 14 working days. Formulir 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:

www.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:

www.online-admission.uph.edu

2. Pilih hasil pendaftaran untuk melihat OFFERING LETTER

Offering Letter sent to applicant’s e-mail address. Offering Letter dikirimkan ke alamat email calon mahasiswa

1

ST

METHOD | METODE 1

2

ND

METHOD | 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

www.uph.edu @uphkonsultasi

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.

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Admission Scholarship and Schedule

Early Admission 1 Early Admission 2

Outside Jabodetabek

Term 1 Term 2 Term 3 Term 4

23 SEPT 2016 11 NOV 2016

11 NOV 2016

20 JAN 2017 03 MAR 2017 05 MAY 2017 23 JUN 2017

08 OCT 2016 26 NOV 2016

26 NOV 2016

04 FEB 2017 25 MAR 2017 19 MAY 2017 14 JUL 2017

SUBMISSION DEADLINE ADMISSION TEST

Best Student

Term 1 Term 2

20 AUG 2016

09 SEPT 2016 11 NOV 2016

02 SEPT 2016 27 JAN 2017

22 AUG - 02 SEPT 2016

13 - 30 SEPT 2016 14 NOV - 25 NOV 2016

TBA TBA

SUBMISSION DEADLINE INTERVIEW SESSION

-10 SEPT 2016 04 FEB 2017 ADMISSION TEST

19 SEPT 2016

17 OCT 2016 02 DEC 2016

17 OCT 2016 13 MAR 2017 ANNOUNCEMENT ADMISSION SCHEDULE 2017/2018

SCHOLARSHIP SCHEDULE 2017/2018 Early Admission 1

Early Admission 2

Outside Jabodetabek

Term 1 Term 3

05 OCT 2016 23 NOV 2016

23 NOV 2016

01 FEB 2017 16 MAY 2017

08 OCT 2016 26 NOV 2016

26 NOV 2016

04 FEB 2017 19 MAY 2017

SUBMISSION DEADLINE ADMISSION TEST

ALL MAJORS EXCEPT MEDICINE

MEDICINE

ALL MAJORS EXCEPT MEDICINE

MEDICINE

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Undergraduate Program

FACULTY MAJOR FULL ENGLISH _CLASS INTERNATIONAL_CLASS DOUBLE/DUAL/_{JOINT DEGREE} _{SCHOOL MAJOR}HIGH

Business School Management - 9 Joint Degree IPA & IPS Accounting - 9 Joint Degree IPA & IPS Faculty of Social and

Political Sciences

Applied Communication Science* 9 - - IPA & IPS International relations 9 - - IPA & IPS Political Science - - - IPA & IPS School of Law Law 9 - - IPA & IPS

School of Design

Architecture - - - IPA & IPS Visual Communication Design - - - IPA & IPS Interior Design - - - IPA & IPS Product Design - - - IPA & IPS

Faculty of Science and Technology

Applied Mathematics - Double Degree IPA

Biotechnology - - - IPA

Electrical Engineering - - - IPA Industrial Engineering - - - IPA Civil Engineering - - - IPA Food Technology 9 - Dual Degree IPA Faculty of

Computer Science

Information System - - - IPA & IPS Informatics - - - IPA & IPS Computer Technology - - - IPA & IPS Faculty of

Psychology Psychology - - - IPA & IPS Conservatory

of Music Music - - - IPA & IPS Faculty of Medicine Medicine - - - IPA School of Hospitality

and Tourism

Hospitality Management 9 - Dual Degree IPA & IPS Travel Industry Management - - - IPA & IPS School of Philosophy

& Divinity Philosophy - - - IPA & IPS Faculty of Nursing

and Apllied Health Sciences**

Nursing - - - IPA & IPS

Faculty of Education -Teachers College**

Biology Education - - - IPA Economic Education - - - IPA & IPS

English Education 9 - Joint Degree IPA & IPS Mathematics Education - - - IPA & IPS Primary Education - - Joint Degree IPA & IPS Chemistry Education - - - IPA

Physics Education - - - IPA Christian Religion Education - - - IPA & IPS

1. Double Degree and Dual Degree Programmes are listed based on information.

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 and International Class from the first term.

4. For Business School Joint Degree must complete 2 (two) application package (UPH & RMIT Application).

* Online Learning also available. ** For admission requirements and further information, please call:

• Faculty of Nursing: (021) 546 0901 ext. 3437 • Teachers College: (021) 546 6057 ext. 2613/2637 • Joint Degree Teachers College: (021) 546 0901 ext. 2257

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NO DOCUMENT

1 Admission Statement (see page 11)

2 Drug Free Statement (see page 13)

3 A Legalized copy of Junior High School National Examination/UN SMP, Academic Records: Grade 10 and 11 (Last 3 years of academic record)

4 A Copy of Valid ID Card (KTP/Kartu Pelajar/SIM/Passport)

5 Full-English Classes Application Form (only for selected majors - see page 25)

6 A copy of TOEFL IBT/IELTS Certificate with minimum score 71 for TOEFL IBT or 5.5 for IELTS (Only for Foreign Student)

Compulsory Requirements For All Majors

Admission Requirements

IMPORTANT!

• All prospective students have to be graduated or on progress to graduate from year 12 / from education equivalent to year 12 level. Semua calon mahasiswa yang mendaft_{ar di UPH wajib telah menyelesaikan atau sedang menempuh pendidikan di kelas 12 / sederajat.}

SENIOR HIGH SCHOOL CATEGORY FINAL CERTIFICATE

National Curriculum

International Curriculum in Indonesia (SPK) High School Certificate & SHUN

Non-Formal Education (PKBM)

PAKET C Informal Education (Homeschooling)

Overseas School Letter of Equivalency

NO DOCUMENT

1 Foreigner Study Permit Issued by Ministry of Education and Culture RI

2 The Indonesian Limited Stay Permit Card

NO MAJOR DOCUMENT

1 Business School International

Program (Int. Class & Joint Degree) A copy of TOEFL IBT/IELTS Certificate with minimum score 71 for TOEFL IBT or 5.5 for IELTS

2 School of Design School of Design application form (see page 17)

3 Conservatory of Music Conservatory of Music Application Form & Conservatory of Music Recommendation Form (see page 19-20)

4 Faculty of Medicine Medical School Application Form & Health Declaration Form (see page 21-22)

5 Faculty of Psychology Faculty of Psychology Application Form (see page 23)

6 Philopsophy School of Philosophy and Divinity Application Form (see page 24)

Additional Requirements

ONLY FOR INDONESIAN STUDENT (WNI)

During Re-Registration

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Additional Requirements For Scholarship

NO DOCUMENT _ACHIEVEMENTACADEMIC _FINANCIALLIMITED _ACHIEVEMENTART _ACHIEVEMENTSPORT

1 Scholarship Application Form (see page 15) 9 9 9 9

2 Copy of Family Card/Kartu Keluarga 9 9 9 9

3

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)

9 9 9 9

4 Copy of Achievement Certificate in any fields 9 9 9 9

5 A statement letter of family financial condition, issued by: Church

(for Christian/Catholic) or RT/RW/Kelurahan (for other religions) - 9 -

-6 Copy of Electricity bill for the last 3 months - 9 -

-7 Copy of water bill for the last 3 months - 9 -

-8 Copy of landline telephone bill for the last 3 months - 9 -

-9 Copy of the last Pajak Bumi dan Bangunan (PBB) payment - 9 -

-10 Copy of Parent’s payslip of income - 9 -

-11 Art & Sport Scholarship Recommendation Form (see page 16) - - 9 9

12 Recent photo (postcard size) using team uniform

(write your name, height and weight behind the photo) - - - 9

13 Copy of Sports Certificate of Performance_{(province/national/international level)} - - - 9

14 Recommendation Letter from Komite Olahraga National Indonesia (KONI) - - - 9

15 Copy of Arts Certificate of Performance

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-Admission Test Regulations

Before The Test

1. 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 must stop doing the test when there is a time up notification.

4. Participants will be disqualified and their registration process will be cancelled should they breach any of the Admission Test

Regulation.

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 pendaft_{arannya 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

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potong disini Form Number

Nomor Formulir Full Name Nama Lengkap High School Name, City Nama SMA, Kota Phone Number Nomor Telepon

1st_Major 2nd_Major 3rd_Major

Mobile Number Nomor HP

PROSPECTIVE STUDENT

ENTRY OPTION (Give tick ( ) in your option)

Direct Admission

Admission Test

Scholarship - Direct Admission

Scholarship - Admission Test (for Medical School)

DOCUMENTS TO BE SUBMITTED (Filled by Staff)

PREFERENCE MAJOR

Place | Tempat Date | Tanggal

Prospective Student’s Signature & Full Name Tanda Tangan & Nama Lengkap Calon Mahasiswa

,

Form Number Nomor Formulir Full Name Nama Lengkap High School Name, City Nama SMA, Kota Phone Number Nomor Telepon

1st_Major

Mobile Number Nomor HP

PROSPECTIVE STUDENT

ENTRY OPTION (Give tick ( ) in your option)

Direct Admission

Admission Test

Scholarship - Direct Admission

Scholarship - Admission Test (for Medical School)

DOCUMENTS TO BE SUBMITTED (Filled by Staff)

PREFERENCE MAJOR

Place | Tempat Date | Tanggal ,

Receipt Form

Copy 1 Admission O

ffi

ce

Receipt Form

Academic Year 2017/2018 UPH Global Campus

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I, the undersigned:

Saya yang bertanda tangan di bawah ini:

Form Number :

Nomor Formulir Full Name :

Nama Lengkap

,

Admission Statement

Copy 1 Admission O

ffi

ce

READ CAREFULLY BEFORE YOU SIGN!

Bacalah dengan seksama sebelum Anda menandatangani!

I understand that the education program of UPH/STPPH is characterized by the Christian Faith and based on the Pancasila and The Constitution of Republic of Indonesia of 1945.

Mengetahui bahwa penyelenggaraan pendidikan di UPH/STPPH bercirikan iman Kristiani dan berdasarkan Pancasila dan Undang-undang Dasar 1945. All documents that I submit are legal and binding. I am fully responsible for any consequences of 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. I am willing to accept sanctions (Dismissal) from UPH/STPPH if I cannot submit a copy of a High School Certificate or Letter of Equivalency or PAKET C certificate during re-registration or in special circumstances by the latest 1 (one) year after effective class begin, even though the tuition fee has been paid. Saya bersedia menanggung sanksi (dikeluarkan) dari UPH/STPPH jika saya tidak dapat menyerahkan fotokopi ijazah SMA Nasional atau Surat Penyetaraan Ijazah atau ijazah PAKET C selama pendaftaran ulang berlangsung atau dalam keadaan tertentu paling lambat 1 tahun setelah perkuliahan dimulai walaupun sudah diterima dan membayar uang kuliah.

I truthfully declare that I have never been given any academic sanction or dismissal from any other university.

Saya menyatakan dengan sebenar-benarnya bahwa saya tidak pernah menerima sanksi akademik atau dikeluarkan dari universitas manapun. As a foreign student, I am obliged to submit the foreign study permit issued by the Republic of Indonesia Ministry of Education and Culture and the Indonesian Limited Stay Permit Card sponsored by UPH.

Sebagai warga negara asing, saya berkewajiban untuk menyerahkan surat ijin belajar warga negara asing yang dikeluarkan oleh Kementrian Pendidikan dan Kebudayaan RI dan kartu ijin tinggal terbatas di Indonesia yang disponsori oleh UPH.

I understand that if I miss the first ten days of class without any notification, I will be considered to have withdrawn from UPH.

Saya mengerti jika saya tidak menghadiri 10 hari pertama perkuliahan tanpa keterangan apapun, maka saya dianggap mengundurkan diri dari UPH. I understand that Double Degree and Dual Degree programmes will start after the first year of class. These programmes are subject to change according 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.

I understand that if the quota of a specific program is full, UPH has the right not to accept any additional studetns in the class even though it is before the payment deadline.

Saya mengerti bahwa jika batas maksimum kapasitas jumlah mahasiswa yang dapat diterima di jurusan tertentu sudah tercapai, maka UPH berhak menolak menambah jumlah mahasiswa dikelas tersebut meskipun belum mencapai batas akhir pembayaran.

UPH is unable to return any documents that have been submitted as part of the application process. UPH tidak dapat mengembalikan semua dokumen persyaratan pendaftaran yang telah dikumpulkan.

Once this document is signed, all payments that are transferred to the Pelita Harapan Foundation belong to the foundation and cannot be refunded for any reason.

Setelah menandatangani dokumen ini, seluruh pembayaran yang telah ditransfer ke Yayasan Universitas Pelita Harapan menjadi milik yayasan dan tidak dapat ditarik kembali dengan alasan dan kondisi apapun.

My parents and I hereby acknowledge and confirmed our acceptance of the consequences of provision number 10 as stated above and we will not file any law suit in connection with provision number 10.

Saya bersama dengan orang tua saya dengan ini menegaskan bahwa kami sudah mengerti dan menerima konsekuensi dari ketentuan point 10 di atas dan oleh karena itu kami tidak akan mengajukan gugatan hukum apapun di kemudian hari sehubungan dengan ketentuan nomor 10.

I agree to abide by the Regulations stated by the University, both now and in the future.

Saya bersedia mentaati Statuta, Peraturan Tata Tertib Kampus, dan peraturan lain yang telah dan akan diberlakukan. I have read and fully understand the regulations and registration requirements stated in this Admission Manual Saya telah membaca dan mengerti ketentuan serta persyaratan pendaftaran dalam Buku Petunjuk Admisi ini. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Hereby affirm that,

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Drug-Free Statement

I, the undersigned:

Form Number :

Nomor Formulir

Full Name :

Nama Lengkap

Place, Date of Birth :

Tempat Tanggal Lahir

Hereby truly state that I : (Mark the corresponding statement)

Dengan ini menyatakan dengan sesunguhnya bahwa saya: (tandai pertanyaan yang sesuai)

Never take drugs nor am i involved with drugs in any forms.

Tidak pernah mengonsumsi narkoba dan terlibat narkoba dalam bentuk apapun.

Took drugs in the past but have been declaired free and clean from drugs, as proven by the official Drugs Exemption Certificate from Siloam Hospital attached.

Pernah mengonsumsi narkoba namun sudah dinyatakan bebas dan bersih dari narkoba, dibuktikan dengan Surat Keterangan Bebas Narkoba resmi dari Rumah Sakit Siloam terlampir.

Furthermore, I am willing to follow UPH’s inspection procedures, including taking random urine and blood tests during my study at UPH.

Selanjutnya, saya bersedia mengikuti prosedur pemeriksaan yang dilakukan secara acak oleh pihak Universitas Pelita Harapan (UPH) termasuk tes urine dan atau darah selama mengiktui proses belajar mengajar di UPH.

I hereby write this statement letter truthfully. I am willing to be processed under the rules in force at UPH, and willing to accept the Dismissal Consequences should my statement prove to be untruthfully.

Demikian surat pernyataan ini saya buat dengan sesungguhnya. Saya bersedia diproses bedasarkan peraturan yang berlaku di UPH, serta bersedia menerima segala konsekuensi termasuk dikeluarkan apabila di kemudian hari pernyataan saya terbukti tidak benar.

PARENT/GUARDIAN’S SIGNATURE & FULL NAME

Tanda Tangan & Nama Lengkap Orang Tua/Wali

PROSPECTIVE STUDENT’S SIGNATURE & FULL NAME

Tanda Tangan & Nama Lengkap Calon Mahasiswa

Stamp Duty/Materai Rp. 6000 ,

Please sign on the stamp duty/

Harap tanda tangan mengenai materai

Please sign on the stamp duty/

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Scholarship Application Form

Scholarship application for all categories

I, the undersigned:

Form Number : Nomor Formulir

Full Name : Nama Lengkap

Social Organization Or Leadership Activities / Aktivitas Sosial, Organisasi Atau Kepemimpinan

Student Council

Red Cross Youth Council

Sport

Band/Orchestra

Choir/Vocal Group

Language Club

Scout

Spiritual Activities

Flag-Raising Squad

Martial Arts

Others,

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)

Scholarship Category / Kategori Beasiswa please tick (9) your option/silahkan beri tanda (9) pada pilihan anda 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}

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Art & Sport Scholarship Recommendation Form

Scholarship application for art achievement or sport achievement category

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

Coach/Teacher’s Signature & Full Name + Stamp (if any) Tanda Tangan & Nama Lengkap Pelatih/Guru + Cap (jika ada)

I, the undersigned:

Coach/Teacher Full Name : Nama lengkap Pelatih/Guru

High School/Institution Name : Nama Sekolah/Institusi

Art

Sport

Coach/Teacher of: Pelatih/Guru

Basketball

Volleyball

Soccer

Swimming

Badminton Guitar

Bass Keyboard

Drum

Piano

Choir

Modern Dance Vocal

Traditional Dance

Acting

Photography

Video Editing

Futsal Coach

Pelatih

Please recommend this prospective student regarding his/her scholarship application: Mohon untuk merekomendasikan Calon Mahasiswa ini pada pendaft_{aran Program Beasiswa:}

pot

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School of Design Application Form

I certify that the above information is true and correct. Saya menyatakan bahwa informasi diatas adalah benar.

Preferred Major | Jurusan Pilihan | Please give tick ( 9) in your option | Silahkan berikan tanda (9) dalam pilihan Anda

Architecture | Arsitek _{Product Design |}_{Desain Produk}

Interior Design | Desain Interior Visual Communication Design | Desain Komunikasi Visual

Additional Requirements

NO DOCUMENT

1 Color Blindness Test Certificate by Ophthalmologist / Oculist

Sertifikat tidak buta warna dari Spesialis Mata

2 One Page Essay (A4; Line Spacing 1,5; Font Size: 12)_{Satu lembar esai (A4; Spasi 1,5; Ukuran Huruf: 12)} Read this quote below:

Bacalah kutipan dibawah ini:

“Design, to its essence, can be defined as the human capacity to shape and make our environment in ways with no direct example produce by nature, to serve our needs and give meaning to our lives.”

“Desain, dalam esensinya, dapat didefinisikan sebagai kapasitas manusia untuk membentuk dan membuat lingkungan dengan cara yang tidak dapat dihasilkan langsung oleh alam, untuk melayani kebutuhan kita dan memberikan makna bagi hidup kita.”

Think carefully about it and write one page essay on what its your understanding about this quote and how this quote means to you as an inspiring designer/ architect. Explain critically.

Pikirkan dengan seksama dan tuliskan satu halaman esai mengenai apa yang Anda pahami dari kutipan ini dan bagaimana kutipan ini Anda maknai sebagai seorang calon desainer atau arsitek. Jelaskan secara kritis.

3 Four (4) pieces hand drawing, A3 size drawing paper: _{Empat lembar gambar tangan, dengan ukuran kertas A3:}

• Two (2) pieces drawing of object or scene in Product Design/Interior Design/Visual Communication Design/Architecture that demonstrates your essay above. Write one paragraph to describe the object/scene you draw and why is it a good design result what you have written.

Dua lembar gambar objek atau adegan Desain Produk/Design Interior/Desain Komunikasi Visual/Arsitektur yang mendemonstrasikan tulisan Anda di atas. Tuliskan satu paragraf dari objek/adegan yang Anda gambarkan dan alasan mengapa contoh tersebut merupakan hasil yang baik yang mencerminkan apa yang sudah Anda tuliskan dalam esai.

• Two (2) pieces drawing of people or human figure/partial human body interacting with an object (gadget, home, objects, furniture, automotive, etc), set within a scene or place (room, outdoor scene, building, street, etc.). Use your preferred technique and tools (pencil, paint, and mix media).

Dua lembar gambar figur manusia/bagian tubuh manusia yang sedang berinteraksi dengan sebuah objek (gadget, perlengkapan rumah, furnitur, otomotif, dsb.), yang di tempatkan dalam sebuah adegan atau tempat (ruangan, diluar ruangan, bangunan, jalan raya, dsb.). Gunakan teknik dan alat yang Anda kuasai (pensil, cat, media campuran).

I, the undersigned:

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NOTES

1. Check the admission requirement and procedure at http://music.uph.edu/admission/procedure.html 2. Applicants for all concentrations have to submit a good quality DVD/VCD recording which refer to website. 3. Applicants may be asked to take a Music Placement Test (Music Theory and Solfeggio).

4. The Recommendation form (p.20) must be completed by the referee.

Conservatory of Music Application Form

Form Number :

Nomor Formulir

Full Name :

Nama Lengkap

High School Name :

Nama Sekolah

PREFERED CONSENTRATION ON YOUR PASSION (CHOOSE ONE)/KONSENTRASI PILIHAN BERDASARKAN MINAT ANDA (PILIH SALAH SATU)

Church Music

Classical Performance

Music Education

Music Theraphy Composition

Jazz & Pop Music Performance

Performing Arts Production & Management

Sound Design & Music Production

CLASSICAL INSTRUMENT NON-CLASSICAL INSTRUMENT

Piano Viola Harp Trumpet Oboe Piano Contra-Bass Trumpet

Vocal Cello Clarinet Trombone Saxophone Vocal Drum Trombone

Guitar Electric Guitar

Violin Electric Bass

Contra-Bass Percussion Percussion Saxophone Bassson Flute French Horn Tuba Flute

Why did you choose UPH Conservatory of Music? Describe. Mengapa Anda memilih Conservatory of Music UPH? Jelaskan. Note:

Prefered concentration will be started on 2nd Academic Year. Konsentrasi Pilihan akan dimulai pada tahun kedua.

How does music impact your life?

Bagaimana musik memberi dampak bagi hidup Anda? Why did you choose your choice consentration? Mengapa Anda memilih pilihan konsentrasi tersebut?

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 mendaft_{ar ke jurusan Musik selain di UPH? Ya/Tidak}

Recent teacher name: _______________________________ Nama guru saat ini

Institution/music schools: ___________________________ Institusi/sekolah music

Music award ever received (if any): ____________________ Penghargaan musik yang pernah diterima (jika ada)

Mention the repertoire that you have learned! Sebutkan repertoar yang pernah Anda pelajari!

Briefly, describe your goals and what influence you to plan a career in music.

NO ADDITIONAL REQUIREMENTS FOR CONSERVATORY OF MUSIC

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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’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

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

Referee /

Pemberi Rekomendasi

REFEREE COMMENTS REGARDING SCHOLARSHIP APPLICANT / Komentar Pemberi Rekomendasi Mengenai Pemohon

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Faculty of Medicine Application Form

By signing this form, I agree to abide by the regulation stated by Faculty of Medicine, both now and in the future. This include all activities and examination that may be held outside of Monday to Friday.

Dengan menandatangani form ini, saya bersedia menaati peraturan yang telah diberlakukan dan akan diberlakukan oleh Fakultas Kedokteran. Hal ini mencakup semua kegiatan dan ujian yang mungkin diadakan diluar hari Senin hingga Jumat.

COMMUNITY INVOLVEMENT

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.

PERSONAL ACHIEVEMENT

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. Form Number :

Nomor Formulir

Place & Date of Birth : Tempat & Tanggal Lahir

Name of Parent : Nama Orang Tua

Name of Family Doctor : Nama Dokter Keluarga

Prospective Student, Calon Mahasiswa

NO ADDITIONAL REQUIREMENTS FOR FACULTY OF MEDICINE

1 Color Blindness Test Certificate by Ophthalmologist / Oculist

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Medical School New Student, Mahasiswa Baru Fakultas Kedokteran

Health Declaration Form

NO HEALTH DECLARATION/PERNYATAAN YES/YA 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 2017 di hari kerja.

I, the undersigned:

You will be required to complete the “Health Declaration Form” prior to join 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.

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Faculty of Psychology Application Form

I, the undersigned:

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 menyatakan bahwa informasi diatas adalah benar.

Preferred Concentration | Konsentrasi Pilihan | Please give tick ( 9) in your option | Silahkan berikan tanda (9) dalam pilihan Anda

Psychology | Psikologi

Psychology & Entreprenurship | Psikologi & Kewirausahaan

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).

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Mobile Number :

Received by,

( ___________________________________ ) Admission Staff’s Signature & Full Name

Verified by

( ___________________________________ ) UPH Language Center’s Signature & Full Name

Full-English Classes Application Form

Prospective Student Who Apply To Full English Class Is Required To Fill This Form

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 30, 2017)

* we accept only TOEFL/IELTS results from LIA, AMINEF, TOEFL/IELTS International

REQUIREMENTS / PERSYARATAN

1. This form is required ONLY for Prospective Student who apply to the available Full English Class as listed below: - 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.

Notes:

- UPH Business School also offers Joint Degree and International Class Program.

- Upon registration, student who applied to Business School International Program (Joint Degree & International Class) and Foreign Student (Non Indonesian Citizen) required to submit TOEFL IBT or IELTS Certificate with minimum score 71 for TOEFL IBT or 5.5 for IELTS.

____________, __________________ Place Date

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Checked By, Diperiksa Oleh,

New Student Re-Registration Form

GENERAL REQUIREMENTS / PERSYARATAN UMUM

CHECK TO BE SUBMITTED / HARUS DILENGKAPI JUMLAH

A copy of Birth Certificate

Fotokopi Akte Kelahiran

1 Piece

1 Lembar

A copy of valid ID/Driving License/Passport

Fotokopi KTP/SIM/Paspor yang masih berlaku

1 Piece

1 Lembar

A recent photos 4x6 using collared shirt with a blue background. Write name and major on the back of the photo.

Pasfoto ukuran 4x6 menggunakan kemeja berkerah dengan berlatar belakang biru. Tuliskan nama dan Jurusan Mahasiswa di bagian belakang foto.

2 Piece

2 Lembar

Receipt of payment legalized by UPH Finance Department

Bukti pelunasan pembayaran SPP/ BPP/SKS yang telah divalidasi oleh Biro Keuangan UPH

1 Piece

1 Lembar

A complete FORM 021 that has been signed by Prospective Student and Parent/Guardian.

FORM 021 yang telah diisi lengkap dan ditandatangani oleh Mahasiswa dan Orangtua/Wali

1 Piece

1 Lembar

Additional Requirements for Foreign Student (Non Indonesian Citizen)

Syarat Tambahan bagi Calon Mahasiswa Warga Negara Asing

CHECK TO BE SUBMITTED / HARUS DILENGKAPI JUMLAH

Foreigner Study Permit issued by Ministry of Education and Culture RI

Surat Izin Belajar Warga Negara Asing yang dikeluarkan oleh Kementerian Pendidikan dan Kebudayaan RI

1 Piece

1 Lembar

The Indonesian Limited Stay Permit Card

Kartu Izin Tinggal Terbatas (KITAS) di Indonesia

1 Piece

1 Lembar Overseas School

A Highschool/Diploma’s Equivalent Statement issued by Ministry of Education & Culture RI

Surat Penyetaraan Ijazah/Diploma dari Kementerian Pendidikan dan Kebudayaan Republik Indonesia

1 Piece

1 Lembar Non-Formal Education (PKBM) and Informal Education (Homeschooling)

A Copy of Legalized PAKET C Certificate

Fotokopi Ijazah PAKET C dilegalisasi

1 Piece

1 Lembar

Form 020

Re-Registration ProcedureComplete and submit all the requirements below to the Academic Administration Directorate of UPH/STPPH at Bldg. A 3rd fl. , | Prosedur Daftar Ulang

on July 1- August 31, 2017 during weekdays at 07.30 AM until 4 PM

Lengkapi dan serahkan persyaratan di bawah ini ke Direktorat Administrasi Akademik UPH/STPPH di Gedung A lt.3

pada 1 Juli-31 Agustus 2017 selama hari kerja pukul 07.30 - 16.00 WIB

Additional Requirements for Indonesian Student

Syarat Tambahan bagi Calon Mahasiswa Warga Negara Indonesia

CHECK National & International Curriculum in Indonesia JUMLAH

A Copy Of High School Final Certificate Legalized by Principal

Fotokopi Ijazah SMA dilegalisasi oleh Kepala Sekolah

1 Piece

1 Lembar

A Copy of National Examination Certificate (SHUN)/Transcript Legalized by Principal

Fotokopi Sertifikat Hasil Ujian Nasional (SHUN)/Transkrip Nilai dilegalisasi oleh Kepala Sekolah

1 Piece

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PARENT/GUARDIAN’S FULL NAME & SIGNATURE

Tanda Tangan & Nama Lengkap Orang Tua/Wali

PROSPECTIVE STUDENT’S SIGNATURE & FULL NAME

Tanda Tangan & Nama Lengkap Calon Mahasiswa

New Student Re-Registration Form

Form 020

Fill in with Capital Letter

Isi dengan huruf cetak

Form Number : Major : Nomor Formulir Jurusan

NO Details | Keterangan Students Data | Data Mahasiswa/i

1 Full Name *) | Nama Lengkap *)

2 Date/Place of Birth *) | Tempat/Tanggal Lahir *) DD-MM-YY

3 Sex | Jenis Kelamin ( ___ ) Male | Laki - laki ( ___ ) Female | Perempuan

4 Civilian Status | Status Sipil ( ___ ) Married | Menikah ( ___ ) Unmarried | Belum Menikah

5 Religion | Agama

6 Nationality | Kewarganegaraan

7 Full Address (Include Residence & Zip Code) |_{Alamat Lengkap (Perumahan, RT/RW & Kode Pos)} 8 High School (Name & Address)_{Asal Sekolah (Nama & Alamat)}

9 Phone & Mobile Phone | No. Telp dan HP 10 e-mail Address | Alamat e-mail 11 ID Card or Driving License Number | _{No. KTP / No. SIM}

NO Details | Keterangan Father’s Data | Data Ayah

1 Full Name *) | Nama Lengkap *) 2 Religion | Agama

3 Nationality | Kewarganegaraan

4 Full Address (Include Residence & Zip Code) |_{Alamat Lengkap (Perumahan, RT/RW & Kode Pos)} 5 Phone & Mobile Phone | No. Telp dan HP

6 E-mail Address | Alamat Email

(Penting untuk Laporan Nilai Ujian per Semester)

7 Recent Education | Pendidikan Terakhir

8 Occupation | Pekerjaan

10 e-mail Address | Alamat e-mail

NO Details | Keterangan Mother’s Data | Data Ibu

1 Full Name *) | Nama Lengkap *) 2 Religion | Agama

3 Nationality | Kewarganegaraan

4 Full Address (Include Residence & Zip Code) |_{Alamat Lengkap (Perumahan, RT/RW & Kode Pos)} 5 Phone & Mobile Phone | No. Telp dan HP

6 E-mail Address | Alamat Email_{(Penting untuk Laporan Nilai Ujian per Semester)} 7 Recent Education | Pendidikan Terakhir

10 e-mail Address | Alamat e-mail

I affirm the above information is true.

Saya tegaskan informasi di atas adalah benar.

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SPECIMEN

Admission Statement

Copy 2 Prospective Student

Hereby affirm that,

dengan ini menegaskan bahwa, 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. ,