International Student Registration Form
PERSONAL DETAILS
Full Name
*
(according to birth certificate or passport)
Gender
*
Male
Female
Nationality
*
Date of Birth
*
Place of Birth
*
Current Address
*
Permanent Address
*
Contact Number
*
Email Address
*
PASSPORT/NATIONAL IDENTITY INFORMATION
Passport Number
*
Date of Issue
*
Issue at
*
Valid Until
*
KITAS/KITAP/LIVING PERMIT INFORMATION**
NIORA
Stay/Multiple Entries Permit Expiry
Permit Number
Valid Until
Stay Permit Index
** not required if you don't have a sponsor
EMERGENCY CONTACT PERSON
Name
*
Occupation
*
Address
*
Contact Number
*
Email Address
*
Relationship with the applicant
*
Family
Friend
Relative
Other
ACADEMIC BACKGROUND
Institution Name
*
Average Final Score/GPA
*
Level of Study
*
Senior High School
Diploma
Undergraduate
Postgraduate
PROFICIENCY IN ENGLISH LANGUAGE
Evidence of language proficiency (not applicable for native English speakers) or for Summer Programme
*
TOEFL Score :
IETLS Score :
Other equivalent English Test :
**Please attach a letter from home institution indicating good English proficiency, if none of the above applies.
TYPE OF PROGRAMME APPLIED
Degree Program
Bachelor
Master
Doctoral
Non-Degree Program
Exchange
Internship
Other
Major of Choice
Diploma Degree
Medical Records and Health Information
Survey and Mapping
Bachelor Degree
Business Management
Accounting International
Informatics Engineering
Informatics System
Visual Communication Design
Product Design
Interior Design
Law
Public Health
Nutrition Sciences
Medical Records & Health Information
Nursing
Nurse Profession
Dietitian
Pharmacy
Biotechnology
Public Relations
Physiotherapy
Psychology
Communication
English Education
Industrial Engineering
Master Degree
Management
Accounting
Public Administration
Physiotherapy
Computer Science
Law
Communication
Doctoral Degree
Management
FINANCIAL SUPPORT
Self-financed
Scholarship :
Others :
REQUIREMENT DOCUMENTS
Transcript
*
Degree Certificate
*
Passport
*
Photo
*
KITAS
**
**if you already have the sponsor
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