UNIVERSITAS PELITA HARAPAN MESSAGE FROM RECTOR. Welcome to UPH Global Campus, Selamat datang di UPH Global Campus,

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Global Perspective. Global Campus.

UNIVERSITAS PELITA HARAPAN

MESSAGE FROM RECTOR

Welcome to UPH Global Campus,

Selamat datang di UPH Global Campus,

This Admission Manual Book has been prepared to provide you with comprehensive information

regarding UPH Faculty, Double Degree Program, Dual Degree Program, admission requirements and

procedures and ﬁnancial regulation.

Buku Manual Admission ini dipersiapkan secara menyeluruh mencakup informasi yang berkaitan dengan fakultas dan

jurusan di UPH, Program Double Degree, Program Dual Degree, prosedur dan persyaratan pendaftaran serta peraturan

keuangan.

We are eager to have you in the UPH family and introduce you to the vision of our university, which

is: True Knowledge, Faith in God and Godly Character.

Kami ingin Anda dapat bergabung dengan kami dan memperkenalkan Anda tentang visi UPH, yaitu: True Knowledge,

Faith in God and Godly Character.

UPH is committed in serving you in the best possible ways, providing a holistic education and learning

with an internationally qualiﬁed lecturers and professors, world-class facilities, technology, and

infrastructure. UPH also prepares students to be globally respected and appreciated by modern

industries and businesses.

UPH berkomitmen melayani Anda dengan cara yang baik, menyediakan pendidikan serta pengajaran holistik, dengan

pengajar, teknologi dan infrastruktur berkualitas internasional. UPH juga mempersiapkan mahasiswa agar dapat bersaing

secara global di bidang industri dan bisnis modern

.

I welcome you to UPH, Global Campus in Indonesia where learning is fun and excellent holistic

education is open to you.

Selamat datang di UPH, Global Campus di Indonesia yang menyediakan pembelajaran menarik dengan pendidikan holistik

terbaik.

Lippo Village, May 20

th

₂₀₁₃

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

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UNIVERSITAS PELITA HARAPAN

TABLE OF CONTENT

ii

Message from Rector

Table of Content

Admission & Scholarship Schedule

Undergraduate Program

Entry Option

Admission Process

Admission Statement Specimen

Admission Requirement & Additional Requirement for Scholarship

Form Receipt

Admission Statement

Scholarship Application Form

Art & Sport Scholarship Recommendation Form

Faculty of Medicine Application Form

Conservatory of Music Application Form

Full-English Classes Application Form

New Student Re-Registration Form

Admission Test Regulation

Admission Form Guidelines

Table

i

ii

1 2 - 3

4

5

6 7 - 8

9

11

13

14

15

17

19

21

23

24

26 UNIVER

SIT

AS PELIT

A HARAP

AN

ADMISSION & SCHOLAR

SHIP SCHEDULE

Gl obal P er spectiv e. Global Campus.

1 ADMISSION SCHEDULE

Mon

th

Term

Gelombang

Augus t 2013 Oct ober 2013 Jan uar y 2014 Sep tember 2013 No vember 2013 December 2013 Februar y 2014 Ma rch 2014 Apri l 2014 M ay 2014 Jun e 2014 Jul y 2014

Early Admissi

on 1

Ge lombang P endaft aran Awal I Dir

ect Admission Submissi

on Deadline Bat as akhir pendaft aran Admission T es t

Ujian Saringan Masuk

Dir

Outsi

de Jabode

tabek

Ge lombang Luar K ot a

Early Admissi

on 2

Ge lombang P endaft aran Awal II

Term 1

_Gelombang 1

_{Term 2}

Ge lombang 2

_{Term 3}

Ge lombang 3

_{Term 4}

Ge lombang 4

No

01

02

03

04

05

06

07

28 Sep t 12 Oct 23 No v 7 Dec 14 Dec 14 Dec 24 Jan 8 F eb 14 Mar 9 Ma y 24 Ma y 27 Jun 12 Jul 29 Mar

SCHOLAR

SHIP SCHEDULE

Mon

th

Term

Gelombang

Augus t 2013 Oct ober 2013 Jan uar y 2014 Sep tember 2013 No vember 2013 December 2013 Februar y 2014 Ma rch 2014 Apri l 2014 M ay 2014 Jun e 2014 Jul y 2014

Scho

lar

ship T

erm 1

Pendaft aran Be asis wa T ahap 1

Scho

lar

ship T

erm 2

Pendaft aran Be asis wa T ahap 2

Scho

lar

ship F

aculty of

Medicine T

erm 1

Pendaft aran Be asis wa F ak ult as K edok te ran Tahap 1

Scho

lar

ship F

aculty of

Medicine T

erm 2

Pendaft aran Be asis wa F ak ult as K edok te ran Tahap 2 Dir

on Deadline Bat as akhir pendaft aran In ter vie w Session Sesi W awanc ara Announcemen t Pengumuman Dir

Ujuan Saringan Masuk In

ter vie w Session Sesi W awanc ara Announcemen t Pengumuman Dir

Ujuan Saringan Masuk In

ter vie w Session Sesi W awanc ara Announcemen t Pengumuman

No

01

02

03

04

20 Sep t 22 No v 5 Oct 21-25 Oct 2 Oct 21 Oct 1 No v 15-22 No v 5 F eb 8 F eb 17 - 21 F eb 3 Dec 14 Mar 20 Sep t - 4 Oct Da tes ar e subje ct t o chang e, please visit w w w .uph.edu | Tanggal dapat be rubah se wak tu-wak tu, lihat w w w .uph.e du un tuk t anggal t erbaru.

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UNIVERSITAS PELITA HARAPAN

UNDERGRADUATE PROGRAM

Management Available

English & Mathematics English & Mathematics Bussiness School

FACULTY

MAJOR

FULL ENGLISH CLASS

ADMISSION TEST SUBJECT

SINGLE DEGREE

TOTAL TERM/

SEMESTER* DEGREE

9 S.E.

Accounting Available 9 S.E.

School of Design (SoD)

English, Mathematics & Drawing English, Mathematics & Drawing English, Mathematics & Drawing English, Mathematics & Drawing

Not Available 11 - 12

Architecture

Not Available 9 - 11

S.Ars. Visual Communication Design

Available 9 - 11 S.Sn.

S.Sn. Interior Design

Not Available 9 - 11 S.Sn.

Product Design

Faculty of Science and Technology (FaST)

S.T.P

Food Technology Available English, Mathematics, Biology &_Chemistry 10

10

English, Mathematics & Physics

Civil Engineering Not Available 10 S.T.

Faculty of Social and Political Science (FISIP)

English & Mathematics English & Mathematics School of Applied Communication

Sciences Available 9 S.I.Kom

School of Government and

Global Aﬀairs Available 9 S.Sos.

Faculty of Computer Science (FIK)

English & Mathematics English & Mathematics English & Mathematics

Information system Not Available 9 S.SI.

Informatics Not Available 9 S.Inf.

Computer System Not Available 9 S.Kom.

School of Hospitality and Tourism (STPPH)

English & Tourism Knowledge

Hospitality Management Available 9 S.S.T.Par.

English & Tourism Knowledge

Travel Industry Management Not Available 9 S.S.T.Par.

Hospitality Management (S.S.T.Par.) & Management (S.E)

School of Law (FH) Law Available English & Mathematics 9 S.H.

Conservatory of Music Music Not Available Not Available 9 - 11 S.Sn.

Faculty of Medicine (FK) Medicine Not Available English, Mathematics, Biology &_Chemistry 10* dr.

Faculty of Education (FIP) Teachers College **Get S.Kep.Ns. with additional 2 semesters

English Education, Primary Education, Biology Education, Economics Education,

Mathematics Education Available 8* S.Pd.

Faculty of Psychology (F.Psi) Psychology Not Available English & Mathematics 9 S.Psi.

Faculty of Nursing and Allied Health

Sciences (FoN) Nursing Not Available Psikotest 9 S.Kep.**

English, Mathematics & Physics

Electrical Engineering Not Available 10 S.T.

English & Mathematics S.Si.

Not Available

Applied Mathematics 10 Applied Mathematics (S.Si) & Informatics (S.Inf.)

Applied Mathematics (S.Si) & Management (S.E) S.Si.

Not Available

Biotechnology English, Mathematics, Biology &_Chemistry

English, Mathematics & Physics S.T.

Industrial Engineering Not Available 10

UNIVERSITAS PELITA HARAPAN

UNDERGRADUATE PROGRAM

DEGREE

DOUBLE DEGREE

DUAL DEGREE

Joint Degree: UPH (S.E) & Royal Melbourne Institute of Technology Melbourne Australia (Bachelor of Business (Accountancy)) Information System (S.SI.) &

Accounting (S.E.) Food, Technology, Computer System, Applied Mathematics, Hospitality Mgt. &

Travel Industry Mgt.

Check on majors below: UPH (S.E.) & La Trobe University, Melbourne - Australia (Bachelor of Business / Bachelor of International Business) UPH (S.E) & Royal Melbourne Institute of Technology (RMIT) Melbourne Australia (B.Bus)

Joint Degree: UPH (S.E) & Royal Melbourne Institute of Technology Melbourne Australia (Bachelor of Business (Management)) Joint Degree: UPH (S.E) & Royal Melbourne Institute of Technology Melbourne Australia (Bachelor of Business (Marketing))

S.Ars. S.Sn. S.Sn. S.Sn. Not Available Not Available Not Available Not Available Not Available Not Available Not Available

UPH (S.Sn.) & Queensland University of Technology, Brisbane - Australia (Bachelor of Design)

Food Technology (S.T.P.) &

Management (S.E.) UPH (S.T.P.) & University of Newcastle, New South Wales - Australia (Bachelor of Food Science and Human Nutrition) Not Available UPH (S.T.) & Hanzehogeschool Groningen, Netherland (Civiele Techniek Ingenieur)

S.I.Kom S.Sos.

Not Available Not Available

UPH (S.E) & Royal Melbourne Institute of Technology (RMIT) Melbourne Australia Bachelor of Communication (Professional Communication) Not Available

S.Inf. S.Kom.

Information System (S.SI.) & Accounting (S.E.) Informatics (S.Inf) & Applied Mathematics (S.Si.) Computer System (S.Kom) &

Management (S.E.) Not Available Not Available Not Available S.S.T.Par. S.S.T.Par.

Hospitality Management (S.S.T.Par.) & Management (S.E) Travel Industry (S.S.T.Par.) &

Management (S.E) Not Available

UPH (S.ST.Par) & International College of Hotel Management, Adelaide - Australia (Bachelor of Hotel Management) UPH (S.ST.Par) & International Hotel Management Institute, Lucerne - Switzerland (Bachelor of Arts)

UPH (S.H.) & Murdoch University, Perth - Australia (Bachelor of Common Law) Not Available

S.Sn. Not Available Not Available

S.Pd. For Admission Requirement and further information, please call 021.546057 ext.2613/2637 or email TC@uph.edu

S.Psi. Not Available Not Available

S.Kep.** Not Available Not Available

Applied Mathematics (S.Si) & Informatics (S.Inf.)

Applied Mathematics (S.Si) & Management (S.E) Not Available

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UNIVER

SIT

AS PELIT

A HARAP

AN

ENTR

Y OP

TION

4

Da tes ar e subject t o chang e, please visit w w w .uph.edu f or upda te da te | T ang gal dapa t berubah se w ak tu-w ak tu, liha t w w w .uph.edu un tuk t ang gal t erbaru

DIRE

CT ADMISSION SUBMISSION DE

ADLINE

EA 1 28 S ep t 2013 EA 2 7 Dec 2013 TERM 1 24 Jan 2014 TERM 2 14 Mar 2014 TERM 3 9 Ma y 2014 TERM 4 27 June 2014 Outs ide Jabode tabek 23 No v 2013

ADMISSION TE

ST SCHEDULE

EA 1 12 Oct 2013 EA 2 14 Dec 2013 TERM 1 8 F eb 2014 TERM 2 29 Mar 2014 TERM 3 24 Ma y 2014 TERM 4 12 Jul 2014 Outs ide Jabode tabek 14 Dec 2013

SCHOLAR

SHIP SCHEDULE

TERM 1

All Major

s (Ex

cep

t Medicine)

Faculty of Medicine

Submission Deadline

In

ter

vie

w Session

Announcemen

t

Admission T

es

t

In

ter

vie

w Session

Announcemen

t

20 Sep

t 2013

20 Se p - 4 Oct 2013

21 Oct 2013

5 Oct 2013

_{21-25 Oct 2013}

22 No

v 2013

8 F

eb 2014

17-21 F

eb 2014

14 Mar 2014

Submission Deadline

2 Oct 2013

5 F

eb 2014

1 No

v 2013

15-22 No

v 2013

3 Dec 2013

TERM 2

DIRE

CT ADMISSION

ADMISSION TE

ST

SCHOLAR

SHIP - DIRE

CT ADMISSION

SCHOLAR

SHIP - ADMISSION TE

ST

A non tes t e ntr y op tion for Pr ospectiv e S tude nt apply ing to all major ex ce pt F acul ty of me di ci ne. Ma ximum of thr ee chos en major s ar e al lo w ed in one re gis tr ation. Merupak an jalur masuk tanpa ujia n bagi Ca lo n Mahasis wa yang mendaft ar reg ula r di semua jurusan k ecuali Fak ul tas K edok tera n. Calo n Mahasis wa dapat memilih tiga jurusan. A t es t e ntr y op tion which f or Pr os pectiv e Studen t apply ing for F aculty of Me dicine . Ma ximum of four t es t sittings all ow ed i n one ac ademic y ear . Merupak an jalur masuk melalu i ujia n bagi Calo n Mahasis wa yang mendaft ar jurusan K edok

teran dan dapat me

ngik uti mak simal e mpat k al i ujian per t ahun. A t es t e ntr y op tion is also a vail abl e t o appl ic an t who is not acce pt ed thr ough the Dir ect Admi ssion, e xce pt the Cons er va tor y of Mus ic. Ma ximum of thr ee chos en major s ar e allo w ed in one t es t Jalu r in i berlak u juga bagi C al on Mahasi

swa yang tidak

lol os selek si Direct Admis sio n, k ecuali Co nser vat or

y of Music. Calon Mahasis

wa dapat me mi lih tiga jurusan. A non tes t e ntr y op tion, whi ch is appl ic able t o pr ospectiv e s tuden ts appl ying f or schola rshi p. Onl y one chos en major all ow ed. Merupak an jalur masuk tanpa ujia n bagi Ca lo n Mahasis wa yang mendaft ar Program Beasis wa di semua jurusan k ecuali Fak ul tas K edok tera n. Calo n Mahasis wa han ya dapat memil ih satu jurusan. A t es t e ntr y op tion which is appl ic able t o pr ospectiv e s tuden t apply ing for schol ar ship for F aculty of Me dicine . Merupak an jalur masuk melalu i ujia n bagi Ca lo n Mahasis wa yang mendaft ar Pro gram Beasis wa un tuk jurusan K edok teran. Regis tr ation to UPH by: - R egis tr ation Form - Online Admis sion Mendaft ar k e UPH melalu i - F ormuli r P endaft aran - P endaft aran Onl ine

UNIVER

SIT

AS PELIT

A HARAP

AN

ADMISSION PR

OCE

SS

5 RE

GULAR

DIRE

CT ADMISSION

ADMISSION TE

ST

DIRE

CT ADMISSION

(F

OR O

THER MA

JOR

S)

PR

OCE

SS

7 - 14 Da

y a

fter

comple

ted

documen

ts ha

ve

been submitt

ed t

o

admission oﬃce.

ADMISSION TE

ST

(F

OR F

ACUL

TY OF MEDICINE)

SCHOLAR

SHIP

if F

ailed

Pass

PR

OCE

SS

In

ter

vie

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faculty member

.

RE

SUL

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Do

wnload Oﬀ

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t

Http://klik.uph.edu/

admission/

announcemen

t.

Pa

ymen

t Pr

ocess

Based on oﬀ

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tter

.

Unif

orm Fitting

Schedule a

t w

w

.uph.edu.

Taking Phot

o f

or UPH Smart Car

d

Schedule a

t w

w

.uph.edu.

UPH F

es

tiv

al

Join UPH F

es

tiv

al as a Ne

w Studen

ts

Orien

ta

tion.

For updat

e, please ﬁnd further de

tailed inf

ormation at : w

w

.uph.edu or email t

o : undergraduat

e.admission@uph.edu

Comple

te The R

e-R

egis

tr

ation F

orm

Comple

te R

e-R

egis

tr

ation F

orm ( see

Admission Manual - F

orm 020/021) and

submit t

o AD

AK Depart

emen

t Building A

,

3

rd

ﬂoor be

for

e July 18, 2014.

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UNIVERSITAS PELITA HARAPAN

ADMISSION STATEMENT

Place

Tempat

Date

,

Tanggal

Please sign on the stamp/Harap tanda tangan mengenai materai.

PARENT/GUARDIAN’S FULL NAME & SIGNATURE

PROSPECTIVE STUDENT’S SIGNATURE & FULL NAME

Stamp Duty/

Materai

Rp.

6000,-READ CAREFULLY BEFORE YOU SIGN!

Bacalah dengan seksama sebelum Anda menandatangani!

This Admission Statement is an agreement between Prospective Students and UPH/STPPH as an institution.

Pernyataan Pendaftaran adalah perjanjian antara mahasiswa Calon dan UPH/STPPH sebagai sebuah institusi.

Form Number :

Nomor Formulir

Full Name

:

Nama Lengkap

I, the undersigned below

Saya, yang bertanda tangan di bawah ini,

Hereby aﬃrm that,

dengan ini menegaskan bahwa,

1. I will not in any conduct against the law; bring, consume, and/or distribute illegal drugs or alcoholic drinks. The right to be a student of UPH/STPPH

will be denied should I fail the health examination/drug examination.

Tidak akan melakukan semua perbuatan yang melanggar hukum; membawa, mengkonsumsi serta mengedarkan obat terlarang (Narkoba)/minuman

keras. Hak sebagai mahasiswa UPH/STPPH akan gugur bila tidak lulus dalam tes kesehatan/tes narkoba.

2. I am not color blind (for Medicine & Design Major) – proved by Certiﬁcate of Color Blind.

Saya tidak buta warna (khusus Kedokteran & Design) dibuktikan dengan Surat Keterangan Tidak Buta Warna.

3. I am willing to participate in a blood/urine examination at any given time by UPH/STPPH.

Bersedia melakukan tes darah/urine yang sewaktu-waktu akan dilakukan oleh pihak UPH/STPPH.

4. The education program of UPH/STPPH is characterized by the Christian Faith, based on the Pancasila and UUD 1945.

Mengetahui bahwa penyelenggaraan pendidikan di UPH/STPPH bercirikan iman Kristiani dan berdasarkan Pancasila & UUD 1945.

5. For Faculty of Psychology : I acknowledge and agree to follow the curriculum in Faculty of Psychology, that is enriched with Christian values.

I am fully aware that there will be Individual counseling as a prerequisite to continue the study into the next semester (Semester 2).

Untuk Fakultas Psikologi : Saya mengetahui dan menyetujui untuk mengikuti pembelajaran di Psikologi Universitas Pelita Harapan yang diperkaya

dengan nilai-nilai Kristiani. Saya menyadari sepenuhnya bahwa akan ada konseling pribadi sebagai persyaratan untuk melanjutkan pembelajaran

semester berikutnya (Semester 2).

6. I am ready to be dismissed from UPH/STPPH if at the end of the ﬁrst 4 semesters I have not yet reached at least 40 credits and have a GPA <2,00,

in accordance with the Rectors Decree No. 450-SKR/UPH/IV/2003 issued on June 25, 2003.

Bersedia dikeluarkan (Drop Out/DO)dari UPH/STPPH jika pada akhir 4 semester pertama belum mengumpulkan minimal 40 SKS dan IPK < 2,00

sesuai dengan SK Rektor No. 450-SKR/UPH/VI/2003 tanggal 25 Juni 2003.

7. I should resign from UPH/STPPH unless I can submit the copy of High School Certiﬁcate or High School Certiﬁcate Equivalency before the end of 2nd

semester, even though the tuition fee has been paid.

Saya harus mengundurkan diri dari UPH/STPPH jika tidak dapat menyerahkan fotokopi ijazah SMA Nasional/Surat Penyetoran Ijazah setelah 2

semester walaupun sudah diterima dan membayar uang kuliah.

8. I have received, understood, signed & I am willing to abide Regulations of the Financial Administration No. 01 – BAKU/PMB/VII/2013.

Saya telah menerima, memahami, menandatangani dan bersedia memenuhi Peraturan Administrasi Keuangan PMB No. 01 – BAKU/PMB/VII/2013.

9. The tuition fee (BPP Pokok, BPP SKS and re-registration) will only be valid for 3 Academic years for S-1/D-4, and 5 Academic years for Faculty of Medicine.

The subsequent semester will be charged with the tuition fee in accordance with the most recent academic years.

Menyetujui biaya studi (BPP Pokok, BPP SKS dan Registrasi Ulang) berlaku selama 3 tahun akademik untuk program S-1/D-4, dan 5 tahun akademik

untuk Fakultas Kedokteran. Untuk semester selanjutnya akan dikenakan biaya studi yang disesuaikan dengan angkatan terbaru.

10. All payments transferred to Pelita Harapan Foundation are declared as the ﬁnal decision, ﬁnalized by the depositor, can’t be refunded for any conditions.

Semua pembayaran yang telah disetor ke Yayasan Pelita Harapan dinyatakan sebagai keputusan akhir dari pihak penyetor dan tidak dapat ditarik

kembali dengan alasan dan kondisi apapun.

11. Recent certiﬁcate of study completion and STTB dan NEM / DNUN / SKHUN /International Certiﬁcate which already equivalence with Ministry of

education and Culture that I own are legal. I am fully responsible for any consequences should there be any false documents.

Ijasah / Surat tanda lulus (STL) / STTB dan NEM / DNUN / SKHUN / Sertiﬁkat Internasional yang sudah disetarakan oleh Diknas terakhir yang saya

miliki adalah sah. Saya akan menanggung akibat apabila berkas tidak sah.

12. I have not been dismissed from UPH/STPPH.

Belum pernah dikeluarkan (Drop Out) dari UPH/STPPH.

13. I am willing to accept all sanctions for any INCORRECT information I have stated.

Bersedia menanggung segala sanksi apabila informasi yang saya berikan TIDAK BENAR.

14. I have read, known, and understood the regulations and registration requirements stated on this Manual Book.

Telah membaca, mengetahui, mengerti ketentuan dan persyaratan pendaftaran dalam Buku Petunjuk ini.

15. I am willing to abide by the Regulations stated by the University, both presently and in the future, within the area of UPH/STPPH.

Bersedia mentaati Statuta, Peraturan Tata Tertib Kampus dan peraturan lain yang telah dan akan diberlakukan di UPH/STPPH.

Copy 1 : Prospective Student

UNIVERSITAS PELITA HARAPAN

ADMISSION REQUIREMENT

COMPULSORY REQUIREMENTS FOR ALL MAJORS

1 Registration Folder

2 Form Receipt (Admission Manual page 9)

3 Admission Statement (Admission Manual page 11)

4 Admission Form (OMR Format)

5 2 Recent photo size 3x4 using white collared shirt with a blue background

6 A copy of valid ID Card (KTP/Kartu Pelajar/SIM)

7 A copy of TOEFL IBT® / IELTS Certiﬁcate with minimum score 61 for TOEFL IBT or

_{5.5 for IELTS (only for non Indonesian passport Holder/WNA)}

8 A copy of legalized Junior High School National Examination/UN SMP

9 A copy of legalized Academic Record: Grade 10 and 11

10 A copy of legalized Senior High School National Certiﬁcate/STTB & UN SMA (Only for

_{high school graduates)}

11 A copy of legalized A Level / AS Level IGCSE Certiﬁcate (minimum 5 subject)

12 A copy of legalized Certiﬁcate Equivalency by Indonesian Education Department or Paket C

13 A copy of legalized IB Predicted / Final Certiﬁcate

14 Full-English Classes Application Form (Admission Manual page 19)

No

Documents

ADDITIONAL REQUIREMENTS FOR SCHOOL OF DESIGN

1 1 (one) page essay: Why I choose X Major Study Program?

2 Color Blindness Test Certiﬁcate by doctor

3 Architecture/Interior Design: 3 (three) hand drawings / portfolios with Drawing Theme: Free, Interior and Exterior

4 DKV: 3 (three) hand drawings / portfolios with media of portfolios: Pencil, Paint and Free Media

5 Product Design: 2 hand drawings with Media: A3-size Paper & Pencil. 1. Industry-based design (gadget, home appliances, automotive, furniture,

_{stationary, etc) and 2. Handicraft-based design (jewelry, furniture, etc). Both preferably an innovation, complete with the uniqueness explanation.}

No

Documents

ADDITIONAL REQUIREMENTS FOR CONSERVATORY OF MUSIC

1 Conservatory of Music Form* (Admission Manual page 17)

2 1 pc video audition in Windows Media Player/MP4/AVI format for each Concentration

3 For procedure and audition requirements (include sample of Theory and Solfeggio Exam), please see http://music.uph.edu/admission/

_{procedure.html}

No

Documents

ADDITIONAL REQUIREMENTS FOR FACULTY OF MEDICINE

1 Faculty of Medicine Form* (Admission Manual page 15)

2 Color Blindness Test Certiﬁcate by doctor

No

Documents

National

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UNIVERSITAS PELITA HARAPAN

ADDITIONAL REQUIREMENT FOR SCHOLARSHIP

8 DOCUMENTS

DOCUMENTS

Achievement

Academic

Category

Limited

Financial

Category

Art

Achievement

Category

Sport

Achievement

Category

No

1 Scholarship Application Form (Admission Manual page 13)

A copy of Family Card/KK

A-500-word English Essay about:

“Why I choose X Major at UPH as a Steping Stone for My Career”

A copy of Parent’s payslip of income

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

Christian/Catholic) or RT/RW/Kelurahan (for non Christian/Catholic)

A copy of electricity bill for the last 3 months

A copy of water bill for the last 3 months

A copy of land telephone bill for the last 3 months

A copy of the last Pajak Bumi dan Bangunan(PBB) Tax payment

Scholarship Recommendation Form (Admission Manual page 14)

A copy of certiﬁcate in respective ﬁeld

A recent photo (postcard size) for sport using team uniforms (write

your name, height and weight behind the photo)

A copy of certiﬁcate of performance (province/national/international

level)

Recommendation Letter from Komite Olahraga National Indonesia (KONI)

2

3

4

5

6

7

8

9

10

11

12

13

14 For further information about Scholarship Program, please see www.uph.edu/admission/undergraduate-scholarship.html

Prospective Students Information

Form Number

:

Nomor Formulir

Full Name

:

Nama Lengkap

School Name, City :

Nama Sekolah, Kota

Copy 2 : Admission Oﬃce

Entry Option

Please give tick (v) in your option

Silahkan berikan tanda (v) pada pilihan Anda

Direct Admission

Admission Test

Scholarship - Direct Admission

Scholarship - Admission Test ( Only for Faculty of Medicine)

Preference Major

1

st

_Major

Code :

2

nd

_Major

₃

rd

_Major

Major

Nama Jurusan :

Major

Nama Jurusan :

Major

Nama Jurusan :

Place

Applicant Signature & Full Name

Tandatangan & Nama Lengkap Calon Mahasiswa

Tempat

Date

,

Tanggal

UNIVERSITAS PELITA HARAPAN

FORM RECEIPT

Phone Number

:

Nomor Telephone

Mobile Phone

:

Nomor Hp

Prospective Students Information

Form Number

:

Nomor Formulir

Full Name

:

Nama Lengkap

School Name, City :

Nama Sekolah, Kota

Copy 1 : Prospective Students

Entry Option

Please give tick (v) in your option

Direct Admission

Admission Test

Scholarship - Direct Admission

Scholarship - Admission Test ( Only for Faculty of Medicine)

Preference Major

1

st

_Major

Code :

2

nd

_Major

₃

rd

_Major

Major

Nama Jurusan :

Major

Nama Jurusan :

Major

Nama Jurusan :

Place

Admission Staﬀ Signature & Full Name

Tandatangan & Nama Lengkap Staf Admisi

Tempat

Date

,

Tanggal

UNIVERSITAS PELITA HARAPAN

FORM RECEIPT

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UNIVERSITAS PELITA HARAPAN

ADMISSION STATEMENT

Place

Tempat

Date

,

Tanggal

Please sign on the stamp/Harap tanda tangan mengenai materai.

PARENT/GUARDIAN’S FULL NAME & SIGNATURE

PROSPECTIVE STUDENT’S SIGNATURE & FULL NAME

Stamp Duty/

Materai

Rp.

6000,-READ CAREFULLY BEFORE YOU SIGN!

Bacalah dengan seksama sebelum Anda menandatangani!

This Admission Statement is an agreement between Prospective Students and UPH/STPPH as an institution.

Pernyataan Pendaftaran adalah perjanjian antara mahasiswa Calon dan UPH/STPPH sebagai sebuah institusi.

Form Number :

Nomor Formulir

Full Name

:

Nama Lengkap

Hereby aﬃrm that,

dengan ini menegaskan bahwa,

Copy 2 : Admission Oﬃce

1. I will not in any conduct against the law; bring, consume, and/or distribute illegal drugs or alcoholic drinks. The right to be a student of UPH/STPPH

will be denied should I fail the health examination/drug examination.

Tidak akan melakukan semua perbuatan yang melanggar hukum; membawa, mengkonsumsi serta mengedarkan obat terlarang (Narkoba)/minuman

keras. Hak sebagai mahasiswa UPH/STPPH akan gugur bila tidak lulus dalam tes kesehatan/tes narkoba.

2. I am not color blind (for Medicine & Design Major) – proved by Certiﬁcate of Color Blind.

Saya tidak buta warna (khusus Kedokteran & Design) dibuktikan dengan Surat Keterangan Tidak Buta Warna.

3. I am willing to participate in a blood/urine examination at any given time by UPH/STPPH.

Bersedia melakukan tes darah/urine yang sewaktu-waktu akan dilakukan oleh pihak UPH/STPPH.

4. The education program of UPH/STPPH is characterized by the Christian Faith, based on the Pancasila and UUD 1945.

Mengetahui bahwa penyelenggaraan pendidikan di UPH/STPPH bercirikan iman Kristiani dan berdasarkan Pancasila & UUD 1945.

5. For Faculty of Psychology : I acknowledge and agree to follow the curriculum in Faculty of Psychology, that is enriched with Christian values.

I am fully aware that there will be Individual counseling as a prerequisite to continue the study into the next semester (Semester 2).

Untuk Fakultas Psikologi : Saya mengetahui dan menyetujui untuk mengikuti pembelajaran di Psikologi Universitas Pelita Harapan yang diperkaya

dengan nilai-nilai Kristiani. Saya menyadari sepenuhnya bahwa akan ada konseling pribadi sebagai persyaratan untuk melanjutkan pembelajaran

semester berikutnya (Semester 2).

6. I am ready to be dismissed from UPH/STPPH if at the end of the ﬁrst 4 semesters I have not yet reached at least 40 credits and have a GPA <2,00,

in accordance with the Rectors Decree No. 450-SKR/UPH/IV/2003 issued on June 25, 2003.

Bersedia dikeluarkan (Drop Out/DO)dari UPH/STPPH jika pada akhir 4 semester pertama belum mengumpulkan minimal 40 SKS dan IPK < 2,00

sesuai dengan SK Rektor No. 450-SKR/UPH/VI/2003 tanggal 25 Juni 2003.

7. I should resign from UPH/STPPH unless I can submit the copy of High School Certiﬁcate or High School Certiﬁcate Equivalency before the end of 2nd

semester, even though the tuition fee has been paid.

Saya harus mengundurkan diri dari UPH/STPPH jika tidak dapat menyerahkan fotokopi ijazah SMA Nasional/Surat Penyetoran Ijazah setelah 2

semester walaupun sudah diterima dan membayar uang kuliah.

8. I have received, understood, signed & I am willing to abide Regulations of the Financial Administration No. 01 – BAKU/PMB/VII/2013.

Saya telah menerima, memahami, menandatangani dan bersedia memenuhi Peraturan Administrasi Keuangan PMB No. 01 – BAKU/PMB/VII/2013.

9. The tuition fee (BPP Pokok, BPP SKS and re-registration) will only be valid for 3 Academic years for S-1/D-4, and 5 Academic years for Faculty of Medicine.

The subsequent semester will be charged with the tuition fee in accordance with the most recent academic years.

Menyetujui biaya studi (BPP Pokok, BPP SKS dan Registrasi Ulang) berlaku selama 3 tahun akademik untuk program S-1/D-4, dan 5 tahun akademik

untuk Fakultas Kedokteran. Untuk semester selanjutnya akan dikenakan biaya studi yang disesuaikan dengan angkatan terbaru.

10. All payments transferred to Pelita Harapan Foundation are declared as the ﬁnal decision, ﬁnalized by the depositor, can’t be refunded for any conditions.

Semua pembayaran yang telah disetor ke Yayasan Pelita Harapan dinyatakan sebagai keputusan akhir dari pihak penyetor dan tidak dapat ditarik

kembali dengan alasan dan kondisi apapun.

11. Recent certiﬁcate of study completion and STTB dan NEM / DNUN / SKHUN /International Certiﬁcate which already equivalence with Ministry of

education and Culture that I own are legal. I am fully responsible for any consequences should there be any false documents.

Ijasah / Surat tanda lulus (STL) / STTB dan NEM / DNUN / SKHUN / Sertiﬁkat Internasional yang sudah disetarakan oleh Diknas terakhir yang saya

miliki adalah sah. Saya akan menanggung akibat apabila berkas tidak sah.

12. I have not been dismissed from UPH/STPPH.

Belum pernah dikeluarkan (Drop Out) dari UPH/STPPH.

13. I am willing to accept all sanctions for any INCORRECT information I have stated.

Bersedia menanggung segala sanksi apabila informasi yang saya berikan TIDAK BENAR.

14. I have read, known, and understood the regulations and registration requirements stated on this Manual Book.

Telah membaca, mengetahui, mengerti ketentuan dan persyaratan pendaftaran dalam Buku Petunjuk ini.

15. I am willing to abide by the Regulations stated by the University, both presently and in the future, within the area of UPH/STPPH.

Bersedia mentaati Statuta, Peraturan Tata Tertib Kampus dan peraturan lain yang telah dan akan diberlakukan di UPH/STPPH.

Document To be Submitted |

Dokumen kurang yang harus diserahkan (DIISI OLEH STAFF)

No

Document

Dokumen

# |

Jumlah

Document To be Submitted |

Dokumen kurang yang harus diserahkan (DIISI OLEH STAFF)

No

Document

Dokumen

# |

Jumlah

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Staﬀ Signature & Full Name

Tempat

Date

,

Tanggal

Place

Staﬀ Signature & Full Name

Tempat

Date

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UNIVERSITAS PELITA HARAPAN

SCHOLARSHIP APPLICATION FORM

13 SCHOLARSHIP APPLICATION FOR ALL CATEGORIES

Social, Organizational or Leadership Activities at school.

Aktivitas sosial, organisasi atau kepemimpinan di sekolah.

Achievements (Senior High School Level)

.

Penghargaan yang pernah diperoleh (di tingkat SMA).

Scholarship Apply

Jalur Beasiswa

(please attach certiﬁcates that support this information)

(lampirkan fotokopi sertiﬁkat sebagai bukti yang mendukung informasi ini)

Religious Activities in Church.

Aktivitas keagamaan di gereja.

If you are Christian/Catholic, please ﬁll here:

Jika Anda beragama Kristen/Katolik, harap isi keterangan berikut ini:

Church

:

Nama Gereja

Address

:

Alamat Gereja

Join ministry/activities

:

Mengikuti kegiatan pelayanan

Form Number

:

Nomor Formulir

Full Name

:

Nama Lengkap

Place | Tempat

PARENT/GUARDIAN’S FULL NAME & SIGNATURE

Date | Tanggal

,

PROSPECTIVE STUDENT’S SIGNATURE & FULL NAME

I, the undersigned below,

Saya, yang bertanda tangan di bawah ini,

Please give tick (v) in your option

Academic Achievement

Prestasi Akademik

Limited Finance

Kondisi Ekonomi Terbatas

Art Achievement

Prestasi Seni

Sport Achievement

Prestasi Olahraga

I aﬃrm the above information is true.

Saya tegaskan informasi di atas adalah benar.

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UNIVERSITAS PELITA HARAPAN

ART & SPORT SCHOLARSHIP RECOMMENDATION FORM

I, the undersigned below

Saya, yang bertanda tangan di bawah ini,

Coach/Teacher full name :

Nama Lengkap Pelatih/Guru

Coach/Teacher of :

Pelatih / Guru

ART

SPORT

Guitar

Bass

Keyboard

Drum

Piano

Choir

Vocal

Modern Dance

Traditional Dance

Theatre

Other,

Basketball

Volleyball

Soccer

Swimming

Badminton

Photography

Video Editing

Coach/Teacher of :

Pelatih / Guru

Recommend this Prospective Student regarding his/her scholarship application:

Merekomendasikan Calon Mahasiswa ini pada pendaftaran Program Beasiswa:

Recent Photograph (Postcard Size) Foto terbaru (Ukuran Postcard)

High School/Institution :

Sekolah/Institusi

Phone Number & Mobile Phone :

Nomor Telepon & Nomor HP

Place

I aﬃrm the above information is true.

Saya tegaskan informasi di atas adalah benar.

Signature & Full Name + Stamp (if any)

Tandatangan & Nama Lengkap + Cap (Jika ada)

Tempat

Date

,

Tanggal

Form Number

:

Nomor Formulir

Full Name

:

Nama Lengkap

Height

:

Tinggi Badan

cm

Weight :

Berat Badan

kg

Playing Position in Team :

Posisi pada tim

Coach/Teacher of :

Pelatih / Guru

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1.

2.

3. UNIVERSITAS PELITA HARAPAN

FACULTY OF MEDICINE APPLICATION FORM

Prospective Students Information

Community Involvement

Please provide a brief summary of all volunteering, caring, community leadership, religious services and organizations that you have participated.

Jelaskan secara singkat semua bentuk partisipasi Anda pada kegiatan relawan, kepemimpinan, pelayanan keagamaan dan organisasi.

Personal Achievement

Personal Statement

Please attach 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.”

Lampirkan-500-kata esai Bahasa inggris tentang “Mengapa saya tertarik

pada Kedokteran dan bagaimana saya akan menggunakannya untuk

memberikan perawatan kesehatan yang baik bagi masyarakat Indonesia di

masa depan.”

Please provide a brief summary of current sports, artistic, hobbies and interest.

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 :

Place

Prospective Student,

Calon Mahasiswa

Signature & Full Name

Tandatangan & Nama Lengkap

Tempat

Date

,

Tanggal

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UNIVERSITAS PELITA HARAPAN

CONSERVATORY OF MUSIC APPPLICATION FORM

17 FOR CONSERVATORY OF MUSIC APPLICANT

Form Number

:

Nomor Formulir

Full Name

:

Nama Lengkap

School Name

:

Nama Sekolah

Chosen Consentration ( Put Rank 1

st

_{, 2}

nd

_{and 3}

rd

_{based on priority)}

Konsentrasi Pilihan (Pilih berdasarkan prioritas 1, 2 dan 3)

Chosen major instrument: (Please tick one only)

Instrument Pilihan: (Pilih satu saja)

Church Music*

Classical Performance

Music Education: Individual Teaching

Music Education: School Teaching

Music Therapy

Music Composition**

Performing Art and Production Management

Professional Contemporary Performance

Sound Design

Other, ______________________________

Bass

Cello

Flute

Guitar

Drum

Piano

Saxophone

Violin

Vocal

Other, _________

Why do you choose UPH Conservatory of Music?

Mengapa Anda memilih Conservatory of Music UPH?

Why do you choose 1st choice concentration?

Mengapa Anda memilih pilihan konsentrasi pertama?

Why do you choose 2nd choice concentration?

Mengapa Anda memilih pilihan konsentrasi kedua?

Why do you choose 3rd choice concentration?

Mengapa Anda memilih pilihan konsentrasi ketiga?

How does music bring impact to your life.

Deskripsikan bagaimana misik memberi dampak bagi hidup Anda.

Who is your favorite composer or performer? Why?

Siapa composer?performer favorit Anda? Mengapa?

Ensemble playing experiences: Yes/No

Apakah Anda pernah memainkan ensemble? Ya/Tidak

Apply to Conservatory of Music other than UPH? Yes/No

Apakah Anda mendaftar ke jurusan Musik lain selain di UPH? Ya/Tidak.

Lastest teacher name

:

Institution/music schools

:

Music award ever received (if any) :

Mention the repertoire that you have ever learned?

Sebutkan repertoire yang pertama Anda pelajari?

Brieﬂy, describe your goal and inﬂuence that make you planning a career in music.

Jelaskan secara singkat mengenai tujuan dan dampak yang Anda dapat berikan saat berkarir di bidang musik.

Student recent photo

3x4

Foto terbaru Calon Mahasiswa 3x4

1. Student complete the data of Student Information.

2. Check the admission requirement and procedure at www.music.uph.edu

3. Applicants for all concentrations should submit a good DVD/VCD quality recording which contains three

contrasting pieces.

4. Applicants may be asked for Music Placement Test (Music Theory and Solfeggio).

5. The Recommender completes tha data of recommender.

INSTRUCTION

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* Available majors: Piano, Vocal & String

** Available majors: Piano, Voice, Guitar, Bass, Percussion & Drum

UNIVERSITAS PELITA HARAPAN

HEALTH DECLARATION FORM

16 Form Number :

Nomor Formulir

Full Name

:

Nama Lengkap

If you are accepted as a student of the Faculty of Medicine, you will be required to complete the “Health Declaration Form” prior to joining for your classes.

The information provided to us is conﬁdential and will not be used for any other purposes except providing support for the student.

Jika Anda diterima sebagai mahasiswa Fakultas Kedokteran, Anda akan diminta untuk 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.

No

1 Do you have, or have you ever had, any medical conditions or operations in the past 5 years?

_{Apakah Anda memiliki, atau apakah Anda pernah punya, kondisi atau operasi dalam 5 tahun terakhir?}

Have you ever suﬀered from tuberculosis (TB) within the past 12 months?

Apakah Anda pernah menderita tuberkulosis (TB) dalam 12 bulan terakhir?

Has any family member or close contact been treated for TB?

Apakah ada anggota keluarga atau kontak dekat dirawat karena TBC?

Have you had a cough for more than 3 weeks?

Apakah Anda memliki batuk selama lebih dari 3 minggu?

Have you coughed up blood?

Apakah Anda pernah batuk berdarah?

Have you had any unexplained weight loss?

Apakah Anda punya berat badan yang tidak dapat dijelaskan?

Have you suﬀered from night sweats or fever?

Apakah Anda menderita keringatan malam atau demam?

Have you ever had any kind of back, joint or muscle problem?

Apakah Anda memiliki sakit punggung, sendi atau masalah otot?

Have you ever had, Dermatitis, Eczema, Psoriasis or any other skin condition?

Apakah Anda pernah mengalami: Dermatitis, Eksim, Psoriasis atau kondisi kulit lainnya?

Have you ever had a drug, tobacco, nicotine or alcohol problem?

Apakah Anda pernah memiliki masalah narkoba, tembakau, nikotin atau alcohol?

Do you have any diﬃculty with your eyesight, including color blindess?

Apakah Anda memiliki kesulitan dengan penglihatan Anda, termasuk buta warna?

Do you have diﬃculty in hearing?

Apakah Anda memiliki kesulitan pendengaran?

Have you ever suﬀered with chest or lung problems: Asthma, Bronchitis?

Pernahkah Anda menderita dengan dada atau masalah paru-paru, Asma, Bronchitis?

Have you ever had any allergies; including ro drugs, food or latex?

Pernahkah Anda punya alergi, termasuk alergi terhadap obat-obatan, makanan atau lateks?

Have you ever received treatment for bowel or gastric problems?

Apakah Anda menerima pengobatan untuk usus dan lambung masalah?

Do you have any other medical conditions that is not previously mentioned in questions 1 – 15 above?

Apakah Anda memiliki kondisi medis lain yang sebelumnya tidak disebutkan dalam pertanyaan 1 – 15 di atas?

Have you ever suﬀered from any of the following: loss of consciousness including fainting attacks,

blackouts epilepsy?

Pernahkah Anda menderita salah satu dari berikut: kehilangan kesadaran termasuk serangan pingsan, Pemadaman, epilepsi?

Have you ever suﬀered from any of the following: heart disease, diabetes, Hipertension or any other

medical illness?

Pernahkah Anda menderita salah satu dari berikut: penyakit jantung, diabetes, Hipertensi atau penyakit medis lainnya?

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 dapat mempengaruhi kemampuan Anda untuk belajar dan mempraktekkan ilmu kedokteran? (termasuk kecemasan, depresi, menyakiti diri, makan, gangguan, psikologis atau masalah emosional)

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 menghadiri dokter untuk perawatan medis, mengonsumsi obat-obatan atau pada daftar tunggu untuk penilaian rumah sakit atau perawatan?

Do you have impairment/disability (physical or metal) or speciﬁc learning disability which may eﬀect

your ability to study in Faculty of Medicine UPH?

Apakah Anda memilki kerusakan / cacat (ﬁsik atau mental) atau ketidakmampuan belajar tertentu yang dapat mempengaruhi kemampuan Anda untuk belajar di Fakultas Kedokteran UPH?

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

Health Declaration

Pernyataan Kesehatan YesYa TidakNo KeteranganDetails

Place

Tempat

Date

Tanggal

,

Signature & Full Name

Tandatangan & Nama Lengkap

Faculty of Medicine New Students,

Mahasiswa Baru Fakultas Kedokteran

I aﬃrm the above information is true.

Saya tegaskan informasi di atas adalah benar.

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UNIVERSITAS PELITA HARAPAN

CONSERVATORY OF MUSIC RECOMMENDATION FORM

Length of course

:

Lama belajar

Year

Tahun

Frequency / week :

frekuensi / minggu

course / week

latihan / minggu

Hours / course

Jam / latihan

Mobile Phone

:

Nomor Handphone

1. How is the Technical strength in playing the instrument:

a. solid

b. need supervision to be solid

c. diﬃcult to be solid

6. Level of dilligence:

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 the knowledge:

a. Show rapid development in a short amount of time

b. not too fast in showing dilligence to do the work ability by his

her own initiative

c. not too fast and less careful over the given correction not too

fast and less carefull over the given correction

8. Your opinion about the maturity of your student: your opinion

about the maturity of your student:

a. able to show his/her maturity, think logically and critical in a

consistent manner

b. able to show his/her maturity yet fail to accomplish

c. immature and need spesial guidance/attention immature and

need spesial guidance/attention

9. Level of conﬁdence to see your student will be able to succeed

studying at UPH Conservatory of Music with his/her chosen ritmic

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

2. How is the Musical strength in playing the instrument:

a. sensitive and able to perform an outstanding musical showing

diligence to do work

b. sensitive yet need guidance

c. less sensitive

3. Knowledge about Theory of Music:

a. very good in making harmony using S-A-T-B format

b. know basic format is writing S-A-T-B

c. doesn’t have a deep knowledge in thepry of music

4. Knowledge about aural training:

a. well trained in solfegio/ 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 receive any guidance

I Recommend this prospective student regarding his/her application to UPH.

Saya, merekomendasikan Calon Mahasiswa ini untuk mendaftar di UPH.

I Aﬃrm the above information is true.

Saya Tegaskan informasi di atas adalah benar.

Full Name

:

Nama Lengkap

Institution/ School of Music

:

Nama Sekolah Music

RECCOMENDER

Perekomendasi

DETAILS OF RECOMMENDATION

INFORMASI LENGKAP PEREKOMENDASI

Please circle the most appropriate answer based on prospective student’s music skill. Silahkan lingkari jawaban yang paling tepat berdasarkan keterampilan musik mahasiswa calon.

RECOMMENDATION LETTER

SURAT REKOMENDASI

We would like to ask your recommendation of this student regarding his/her application to UPH Conservatory of Music

Kami ingin meminta rekomendasi Anda atas pendaftaran calon mahasiswa ini di UPH Conservatory of Music

Coach / Teacher

Pelatih / Guru

Place Tempat

Date

,

Tanggal

Signature & Full Name + Stamp (if any)

Tandatangan & Nama Lengkap + Cap (Jika ada)

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UNIVERSITAS PELITA HARAPAN

FULL-ENGLISH CLASSES APPLICATION FORM

FORMULIR WAJIB DllSl OLEH MAHASISWA BARU

dari jurusan Manajemen, Akuntansi, llmu Komunikasi, Hubungan lnternasional, Hukum,

Desain lnterior, Teknologi Pangan dan Manajemen Perhotelan ( Sekolah Tinggi Pariwisata dan Perhotelan Pelita Harapan )

THIS FORM REQUIRED TO FILLED BY NEW STUDENTS from Management, Accounting, Communication Studies, lnternational Relations, Law, Interior Design, Food Technology and Hospitality Management (school ol Tourism and Hospitality Pelita Harapan)

Sebagai persyaratan untuk memilih kelas international, maka saya dengan data-data sbb:

As the requirements for selecting an international class, I am with the following data:

Nomor Formulir : ______________________________________ Form Number

Saya, mendaftar untuk mengikuti kelas dalam bahasa Inggris.

I am registering to join Full English Classes

Kelas dalam bahasa Inggris tersedia untuk jurusan Management, Akutansi, Ilmu Komunikasi, Hubungan International, Hukum, Design Interior, Teknologi Pangan

dan Management Perhotelan ( Sekolah Tinggi Pariwisata dan Perhotelan Pelita Harapan )

Full english classes are available for majoring in management,Accounting, Communication Studies, International Relation, Law, Interior Design, Food Technology and Hospitality Managements (School of tourism and Hospitality Pelita Harapan)

Saya mengerti, untuk Kelas yang dibawakan dalam bahasa Inggris, Persyaratan minimum TOEFL 500 harus di penuhi, jika persyaratan TOEFL tidak terpenuhi maka

UPH berhak untuk mengalihkan ke kelas regular.

I fully understood that Full English Classes require a minimum TOEFL PBT of 500. Should the requirement is not yet met, UPH has the right to make a placement to regular class.

Calon Mahasiswa harus melampirkan sertiﬁkat TOEFL IBT atau IELTS atau TOEFL PBT yang asli dan masih berlaku.

Prospective Students must submitted a valid & original certiﬁcate of TOEFL IBT or IELTS or TOEFL PBT.

Jika Calon Mahasiswa mempunyai hasil test selain TOEFL PBT, berikut adalah nilai minimum standar penerimaannya:

If prospective students have other than TOEFL PBT Test Result, the following is minimum conversion standard:

TOEFL PBT

TOEFL IBT

IELTS

Status Penerimaan Kelas dalam bahasa Inggris

Paper Based Test Internet Based Test International English Language Testing System Admission Status

500 59 – 60

5.0 Diterima | Passed

Jika Calon Mahasiswa baru belum mempunyai TOEFL / IELTS maka dapat melakukan English Test di UPH Language Center, sesuai dengan waktu yang telah

ditentukan. Untuk waktu pelaksanaan English Test di UPH Language Center, silahkan periksa di www.uph.edu dibagian Info Center.

If Prospective Students do not have TOEFL / IELTS, S(he) can take the English Test conducted by UPH Language Center as schedule. Please check at www.uph.edu in Info Center section for the schedule.

Mohon menyerahkan formulir ini bersama dengan Formulir Pendaftaran. Bagi yang tidak mengikuti English Test di UPH Language Center harap menyerahkan

fotokopi Sertiﬁkat Test TOEFL / IELTS yang masih berlaku paling lambat 27 Juni 2014.

Please submit this form along with Application Form. For those who do not attend the English Test at UPH Language Center, please submit a copy of valid TOEFL/IELTS Certiﬁcate before June 27th_2014.

Saya mendaftar Full English Class dan mengikuti English Test di UPH Language Center.

I, register Full English Class and English Test at UPH Language Center.

Nama : ______________________________________ Name Jurusan : ______________________________________ Major Nomor Handphone : ______________________________________ Phone Number

Saya mendaftar Full English Class dan menyerahkan hasil fotokopi test TOEFL/IELTS.

I, register Full English Class and submit a copy of TOEFL/IELTS Certiﬁcate.

Saya tidak mengikuti Full English Class.

Iam not register Full English Class.

Tempat | Place, Tanggal | Date

,

( __________________________________ )

Nama Jelas | Complete Name ( __________________________________ )Nama Jelas | Complete Name ( __________________________________ )Nama Jelas | Complete Name Diterima Oleh, Received by, Staff Admisi Admission Staff Prospective Student Calon Mahasiswa Diverifikasi Oleh, Verified by,

UPH Language Center

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(13)

UNIVERSITAS PELITA HARAPAN

NEW STUDENT RE-REGISTRATION FORM

21 Date

Tanggal :

FORM

020

GENERAL REQUIREMENT

PERSYARATAN UMUM

A copy of High School Final Certiﬁcate legalized by Principal.

Fotokopi Ijazah/Surat Tanda Tamat Belajar dilegalisasi oleh Kepala Sekolah.

1 Piece

1 Lembar

1 Piece

1 Lembar

1 Piece

1 Lembar

1 Piece

1 Lembar

4 Pieces

4 Lembar

1 Piece

1 Lembar

1 Piece

1 Lembar

A copy of NEM/STL/STK/SKHUN/TRANSCRIPT legalized by Principal.

Fotokopi NEM/STL/STK/SKHUN/TRANSKRIP Nilai dilegalisasi oleh Kepala Sekolah.

A copy of Birth Certiﬁcate

Fotokopi Akte Kelahiran.

A copy of valid ID/Driving License/Passport

Fotokopi KTP/SIM/Paspor yang masih berlaku.

Receipt of payment legalized by UPH Finance Department

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

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

A recent photos 3x4 using collared shirt with a blue background.

Write name and major on the back of the photo.

Pasfoto ukuran 3x4 menggunakan kemeja berkerah dengan berlatar belakang biru. Tuliskan nama dan Jurusan Mahasiswa di bagian belakang foto.

To be Submitted

|

Harus Dilengkapi

Check

|

Periksa

#

Jumlah

ADDITIONAL REQUIREMENT FOR STUDENT FROM INTERNATIONAL CURRICULUM

SYARAT TAMBAHAN BAGI CALON MAHASISWA DENGAN KURIKULUM INTERNASIONAL

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

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

1 Piece

1 Lembar

To be Submitted

|

Harus Dilengkapi

Check

Periksa

#

|

Jumlah

ADDITIONAL REQUIREMENT FOR STUDENT FROM FOREIGN COUNTRY

SYARAT TAMBAHAN BAGI CALON MAHASISWA WARGA NEGARA ASING

Foreigner Study Permit issued by Ministry of Education and Culture RI

Surat Ijin Belajar Warga Negara Asing yang dikeluarkan oleh Kementrian Pendidikan dan Kebudayaan RI

1 Piece

1 Lembar

Living Permit in Indonesia

Kartu Ijin Menetap Sementara di Indonesia

1 Piece

1 Lembar

To be Submitted

|

Harus Dilengkapi

Check

Periksa

#

|

Jumlah

Checked By,

Diperiksa oleh,

Biro ADAK

( _________________________________ )

Re-Registration Procedure | Prosedur Daftar Ulang

Complete and submit all the requirements below to the Academic Administration Bureau of UPH/STPPH at Bd. A 3

rd

_{ﬂ. , before July 18, 2014.}

Lengkapi dan serahkan persyaratan di bawah ini ke Biro Administrasi Akademik UPH/STPPH di Gedung A lt.3 sebelum 18 Juli 2014.

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