BIPA PROGRAM
LEMBAGA BAHASA INTERNASIONAL
FAKULTAS ILMU PENGETAHUAN BUDAYA
UNIVERSITAS INDONESIA
I. GENERAL
STUDY INFORMATION
•Period of Study : Regular JANUARY- APRIL 2 0 1 * Year
Regular MAY - AUGUST 2 0 1 * Year
Regular SEPTEMBER - DECEMBER 2 0 1 * Year
•Program You Will Take : Only BIPA I Only BIPA II Only BIPA III * 1 term
BIPA I & II BIPA II & III * 2 term
BIPA I, II & III * 3 term
STUDY PERMIT INFORMATION •Study Permit 4 Month
◦ Apply Visit Visa for Socio-Cultural : Personal * Only for students who are going to take study 1 program
* Visit Visa can be extended maximum up to 2 times
•Study Permit 12 Month
◦ Apply Limited Stay Permit for Student Visa : Personal * Only for students who will study for more than 2 program
* Can not be extended
With Spouse With (___) Child With Spouse and (___) Child VISA PROCESS INFORMATION (the Indonesian Embassy to process Telex Visa)
•Embassy Of The Republic of Indonesia (KBRI) : •Consulate General of Republic of Indonesia (KJRI) :
II. PERSONAL DATA
•Surname :
•Given names :
•Sex : Male Female
•Marital Status : Single Married
•Place of Birth :
•Date of Birth :
•Nasionality :
•Home Address :
•City :
•Province / State :
•Phone Number :
•E-mail :
•Postcode :
•Occupation / Position : Student Housewife Professional
Others
•Passport Number ::
◦ Issue Date ::
◦ Expiration Date :
FINANCIAL GUARANTEE RELATION : Personal Parent (Father / Mother) Company
Others
Date: (dd/mm/yyyy) Signature :
photo 3 x 4
