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 quality 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
ii
Contents
Message from The Rector i
Table of Content ii
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
Receipt Form 9
Admission Statement 11
Drug Free Statement 13
Scholarship Application Form 15
Art & Sport Scholarship Recommendation Form 16
School of Design Application Form 17
Conservatory of Music Application Form 19
Conservatory of Music Recommendation Form 20
Faculty of Medicine Application Form 21
Health Declaration Form 22
Faculty of Psychology Application Form 23
School of Phylosophy and Divinity Application Form 24
Full-English Class Application Form 25
New Student Re-Registration Form 27-28
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 AdmissionDirect (Medicine, Homeschooling & PKBM)Admission Test
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 Result
2
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
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
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.
Admission and Scholarship 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 2017SUBMISSION DEADLINE ADMISSION TEST
Best Student Term 1 Term 2 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
4
Undergraduate Program
FACULTY MAJOR FULL ENGLISH CLASS INTERNATIONALPROGRAM DOUBLE/DUAL/JOINT DEGREE SCHOOL MAJORHIGH
Business School Management - Joint Degree IPA & IPS Accounting - Joint Degree IPA & IPS Faculty of Social and
Political Sciences
Applied Communication Science* - - IPA & IPS International relations - - IPA & IPS Political Science - - - IPA & IPS School of Law Law - - 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 - 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 - 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 - 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 Program 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
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 mendaftar 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
(Int. Program & Joint Degree) A copy of TOEFL IBT/IELTS Certificate with minimum score 71 for TOEFL IBT or 5.5 for IELTS or 530 for EAT 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
6
Additional Requirements For Scholarship
NO DOCUMENT ACHIEVEMENTACADEMIC FINANCIALLIMITED ACHIEVEMENTART ACHIEVEMENTSPORT
1 Scholarship Application Form (see page 15) 2 Copy of Family Card/Kartu Keluarga
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)
4 Copy of Achievement Certificate in any fields
5 A statement letter of family financial condition, issued by: Church(for Christian/Catholic) or RT/RW/Kelurahan (for other religions) - -
-6 Copy of Electricity bill for the last 3 months - -
-7 Copy of water bill for the last 3 months - -
-8 Copy of landline telephone bill for the last 3 months - -
-9 Copy of the last Pajak Bumi dan Bangunan (PBB) payment - -
-10 Copy of Parent’s payslip of income - -
-11 Art & Sport Scholarship Recommendation Form (see page 16) -
-12 Recent photo (postcard size) using team uniform(write your name, height and weight behind the photo) - -
-13 Copy of Sports Certificate of Performance(province/national/international level) - -
-14 Recommendation Letter from Komite Olahraga National Indonesia (KONI) - -
-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 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 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.
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 Office
Receipt Form
Academic Year 2017/2018 UPH Global Campus
pot
I, the undersigned:
Saya yang bertanda tangan di bawah ini: Form Number : Nomor Formulir Full Name : Nama Lengkap ,
Admission Statement
Copy 1 Admission Office
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,
pot
Drug-Free Statement
READ CAREFULLY BEFORE YOU SIGN!
Bacalah dengan seksama sebelum Anda menandatangani!
I, the undersigned:
Saya yang bertanda tangan di bawah ini: 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.
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
Stamp Duty/Materai Rp. 6000 ,
Please sign on the stamp duty/
pot
Scholarship Application Form
Scholarship application for all categories
Place | Tempat Date | Tanggal ,
I, the undersigned:
Saya yang bertanda tangan di bawah ini: 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 ( ) your option/silahkan beri tanda ( ) 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 I certify that the above information is true and correct.
16
Art & Sport Scholarship Recommendation Form
Scholarship application for art achievement or sport achievement category
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
Coach/Teacher’s Signature & Full Name + Stamp (if any)
Tanda Tangan & Nama Lengkap Pelatih/Guru + Cap (jika ada)
Place | Tempat Date | Tanggal ,
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
Art
Sport
Coach/Teacher of: Pelatih/Guru Basketball Volleyball Soccer Swimming Badminton Guitar Bass Keyboard Drum Piano Choir Modern Dance Vocal Traditional Dance Acting PhotographyVideo Editing Futsal
Coach
Pelatih
Please recommend this prospective student regarding his/her scholarship application: Mohon untuk merekomendasikan Calon Mahasiswa ini pada pendaftaran Program Beasiswa:
pot
Place | Tempat Date | Tanggal ,
School of Design Application Form
Preferred Major | Jurusan Pilihan | Please give tick ( ) in your option | Silahkan berikan tanda ( ) dalam pilihan Anda
Architecture | Arsitek Product Design | Desain Produk
Interior Design | Desain Interior Visual Communication Design | Desain Komunikasi Visual Additional Requirements
NO DOCUMENT
1
One Page Essay General Thinking Assessment (1 page A4, line spacing 1,5, size 12 font)
Read this quote below, think carefully about it and write one page essay on what is your understanding about this quote and how this quote means to you as an inspiring designer/ architect. Explain.
Baca kutipan dibawah ini, pikirkan dengan seksama dan tuliskan 1 halaman essay mengenai apa yang anda pahami dari kutipan ini dan bagaimana kutipan ini anda maknai sebagai seorang calon desainer atau arsitek. Jelaskan.
“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 diartikan sebagai kemampuan manusia untuk merancang dan membuat lingkungan dengan cara yang tidak dihasilkan langsung oleh alam; untuk melayani kebutuhan kita dan memberikan makna bagi hidup kita.”
2 Color Blindness Test Certificate by Ophthalmologist / OculistSertifikat tidak buta warna dari Spesialis Mata
3
A. Narrative/ Imaginative Assessment (2 piece, A3 Size drawing paper)
Choose 1 between these 2 case studies below: Pilih satu diantara dua studi kasus dibawah ini:
• A Vertical City build attached to cliffs with tallest point of 2 km, stretching 20 km wide, heavily populated with 2 million people. Like any modern cities, this city need public transportation system, housing development, public parks, sport & recreational facilities, commercial district, health facilities, water treatment system, waste management system, schools etc. Because it was built vertically, how would everything be different?
Sebuah Kota Vertikal yang dibangun pada sisi tebing dengan titik tertinggi kota pada ketinggian 2 km, dengan lebar wilayah kota 20 km, dengan kepadatan penduduk 2 juta jiwa. Sama seperti kota-kota modern, kota ini memerlukan sistim transportasi public, pengembangan hunian, taman public, fasilitas olahraga dan rekreasi, distrik komersial, fasilitas Kesehatan, Sistim pengolahan Air, Sistim pengolahan Sampah, Sekolah dsb. Sebagai konsekuensi dari kota yang dibangun vertikal, apa saja yang berbeda?
• Jakarta is a multi-ethnic city, with people from diverse cultural treasures and wisdom. Lately diversity creates tensions; and not many places, objects, or events in the city are deliberately designed to help bring people together to learn, share, and appreciate this diversity. Everybody have very hectic and individual lives that make it difficult to interact with other people’s needs and values.
Jakarta adalah kota multi-etnis, dengan penduduk yang memiliki keanekaragaman kekayaan budaya dan kearifan lokal. Akhir-akhir ini, keanekaragaman ini justru menjadi sumber ketegangan. Tidak banyak tempat, objek, ataupun peristiwa di kota Jakarta yang secara sengaja dirancang untuk membantu mempersatukan penduduknya untuk belajar, berbagi, dan mengapresiasi keanekaragaman ini. Setiap orang memiliki kesibukan dan hidup individual yang mempersulit interaksi yang membantu memahami kebutuhan dan nilai-nilai orang lain.
B. How do you respond to this case-study above as a Product Designer/ Interior Designer/ Visual Communication Designer/ Architect?
Bagaimana anda meresponi studi kasus diatas sebagai seorang desainer Produk/ desainer Interior/ desainer Komunikasi Visual/ Arsitek?
C. Explain why your response is uniquely Product Designer/ Interior Designer/ Visual Communication Designer/ Architect response. Also explain how your solution is specifically designed for the selected case-study situation.
Jelaskan bagaimana respon anda diatas merupakan sesuatu respon unik dalam keilmuan desain Produk/ desain Interior/ desain Komunikasi Visual/ Arsitektur. Jelaskan juga bagaimana solusi yang anda berikan itu secara spesifik dirancang untuk situasi studi kasus yang anda pilih.
D. Draw one place/ object/ scene/ event (in Product Design/ Interior Design/ Visual Communication Design/ Architecture) that demonstrate your solution, complete this drawing with written explanations of how your solution supposed to work.
Gambarkan suatu tempat/ objek/ adegan/ persitiwa (dalam desain Produk/desain Interior/desain Komunikasi Visual/ Arsitektur) yang mendemonstrasikan solusi yang anda tawarkan, lengkapi gambar anda dengan penjelasan tertulis bagaimana solusi desain anda dapat menjawab kebutuhan yang ada.
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Technique/ Composition/ Skill Assessment (2 piece, A3 Size drawing paper)
Draw 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, mixed media etc.)
Gambar sekelompok orang atau figur manusia atau bagian tubuh manusia yang sedang berinteraksi dengan sebuah objek (gadget, perlengkapan rumah, furnitur, otomotif dsb.), yang ditempatkan dalam sebuah adegan atau tempat (misal: ruangan, di luar ruangan, bangunan, jalan raya, dsb.). Gunakan teknik dan alat yang anda kuasai (pensil, cat, mixed media dsb.)
Form Number : Nomor Formulir Full Name : Nama Lengkap
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NOTES
1. Check the admission requirement and procedure at http://music.uph.edu/admission/com-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 mendaftar 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
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
Referee / Pemberi Rekomendasi
REFEREE COMMENTS REGARDING SCHOLARSHIP APPLICANT / Komentar Pemberi Rekomendasi Mengenai Pemohon
I certify that the above information is true and correct. Saya tegaskan informasi diatas adalah benar.
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Faculty of Medicine Application Form
Place | Tempat , Date | Tanggal
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
Full Name : Nama Lengkap
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
2 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.” 3 2 Recent Photo size 3x4 using white collared shirt with blue background
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Prospective Student’s Signature & Full Name
Tanda Tangan & Nama Lengkap Calon Mahasiswa
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?
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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:
Saya yang bertanda tangan di bawah ini: Full Name :
Nama Lengkap
I certify that the above information is true and correct. Saya tegaskan informasi diatas adalah benar.
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.
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.
Prospective Student’s Signature & Full Name
Tanda Tangan & Nama Lengkap Calon Mahasiswa
Place | Tempat Date | Tanggal ,
Faculty of Psychology Application Form
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 menyatakan bahwa informasi diatas adalah benar.
Preferred Concentration | Konsentrasi Pilihan | Please give tick ( ) in your option | Silahkan berikan tanda ( ) 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).
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).
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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 FormForm 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 international.uph.edu (Services). 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 Program.
- Upon registration, student who applied to Business School (Joint Degree & International Program) 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 or 530 for EAT.
____________, __________________ Place Date
( ___________________________________ ) Prospective Student’s Signature & Full Name
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New Student Re-Registration Form
Form 020
Re-Registration Procedure | Prosedur Daftar UlangComplete and submit all the requirements below to the Academic Administration Directorate of UPH/STPPH at Bldg. A 3rd fl. , 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
Checked By, Diperiksa Oleh,
GENERAL REQUIREMENTS / PERSYARATAN UMUM
CHECK TO BE SUBMITTED / HARUS DILENGKAPI JUMLAH
A copy of Birth Certificate
Fotokopi Akte Kelahiran 1 Lembar1 Piece A copy of valid ID/Driving License/Passport
Fotokopi KTP/SIM/Paspor yang masih berlaku 1 Lembar1 Piece 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 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 Lembar1 Piece
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 Research, Technology, and Education RI
Surat Izin Belajar Warga Negara Asing yang dikeluarkan oleh Kementerian Riset, Teknologi, dan Pendidikan Tinggi Republik Indonesia
1 Piece 1 Lembar The Indonesian Limited Stay Permit Card
Kartu Izin Tinggal Terbatas (KITAS) di Indonesia 1 Lembar1 Piece
Overseas School
A Highschool/Diploma’s Equivalent Statement issued by Ministry of Research, Technology, and Education RI
Surat Penyetaraan Ijazah/Diploma dari Kementerian Riset, Teknologi, dan Pendidikan Tinggi Republik Indonesia 1 Lembar1 Piece
Non-Formal Education (PKBM) and Informal Education (Homeschooling)
A Copy of Legalized PAKET C Certificate
Fotokopi Ijazah PAKET C dilegalisasi 1 Lembar1 Piece
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 Lembar1 Piece A Copy of National Examination Certificate (SHUN)/Transcript Legalized by Principal
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Place | Tempat Date | Tanggal
PARENT/GUARDIAN’S FULL NAME & SIGNATURE
Tanda Tangan & Nama Lengkap Orang Tua/Wali PROSPECTIVE STUDENT’S SIGNATURE & FULL NAMETanda Tangan & Nama Lengkap Calon Mahasiswa
New Student Re-Registration Form
Form 021
Fill in with Capital LetterIsi 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 Passpor | No. KTP / No. Passport
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
9 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 8 Occupation | Pekerjaan
9 e-mail Address | Alamat e-mail
I affirm the above information is true. Saya tegaskan informasi
SPECIMEN
Admission Statement
Copy 2 Prospective Student
READ CAREFULLY BEFORE YOU SIGN!
Bacalah dengan seksama sebelum Anda menandatangani!READ CAREFULLY BEFORE YOU SIGN! Bacalah dengan seksama sebelum Anda menandatangani!
Hereby affirm that,
dengan ini menegaskan bahwa, 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. ,
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.
I, the undersigned:
Saya yang bertanda tangan di bawah ini: Form Number :
Nomor Formulir Full Name : Nama Lengkap