Double Degree Program Application Form

(1)

UNIVERSITAS GADJAH MADA FACULTY OF LAW

INTERNATIONAL UNDERGRADUATE PROGRAM (S1-IUP)

*Circle or Strike Through where inappropriate

Serial Number: 01/II/IUPL.UGM/LR/2018

Having completed...credits of my study with Grade Point Average (GPA)………... out of 4.00, I, the undersigned,

Name : ...

Student Number : ...

Mobile Phone # :………

hereby apply for Double Degree Program at School of Law in the University of Maastricht/School of Law in the Charles Darwin University,* starting Semester 1 Academic Year………….…../…..………..

For your consideration, I am enclosing my:

a) Curriculum Vitae

b) copy of student identification card (KTM);

c) Study Plan (KRS) for the current Semester;

d) Academic Transcript with minimum GPA 3.25 signed by Head of Academic and Student Affairs;

e) Copy of IELTS with minimum score 6.5;

f) Motivation Letter;

g) Confidential Reference Form (to be written by a lecturer and send directly via email to [email protected]);

h) Health Certificate;

1. Minnesota Multiphasic Personality Inventory or MMPI Test (taken at dr. Sardjito Hospital,Yogyakarta);

and

2. Health certificate from Doctor.

i) Copy of Passport; and

j) Two identical photographs (3.5 cm x 4.5 cm).

I also give authority to the management of S1-IUP for accessing and examining data of my health certificates especially the enclosed documents of item h (1) & (2).

Date : Signature :

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Acknowledged and approved,

Student’s Parent

...

(name and signature)