International Undergraduate Student Application Form
Full Name (as appears on passport):
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Email Adress
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Nationality
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Native Country
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WhatsApp Number
Fill the
62
with your country code
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Last Education
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-- Choose --
Senior High School
School Name
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1st Choice Study Program
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-- Choose Study Program --
Bachelor of Nursing
Bachelor of Nutrition
Bachelor of Pharmacy
Bachelor of Hospital Administration
Bachelor of Midwifery
Bachelor of Midwifery (RPL)
Bachelor of Nursing (RPL)
Bachelor of Nutrition (RPL)
Bachelor of Hospital Administration (RPL)
Bachelor of Islamic Education
Bachelor of Islamic Elementary Education
Bachelor of Elementary Education
Bachelor of Mathematics Education
Bachelor of Islamic Education (RPL)
Bachelor of Islamic Elementary Education (RPL)
Bachelor of Elementary Education (RPL)
Bachelor of Mathematics Education (RPL)
Bachelor of Islamic Banking
Bachelor of Islamic Economics
Bachelor of Accounting
Bachelor of Management
Bachelor of Islamic Banking (RPL)
Bachelor of Islamic Economics (RPL)
Bachelor of Accounting (RPL)
Bachelor of Management (RPL)
Bachelor of Information System
Bachelor of Informatics
Bachelor of Information System (RPL)
Bachelor of Informatics (RPL)
2nd Choice Study Program
-- Choose Study Program --
Bachelor of Nursing
Bachelor of Nutrition
Bachelor of Pharmacy
Bachelor of Hospital Administration
Bachelor of Midwifery
Bachelor of Midwifery (RPL)
Bachelor of Nursing (RPL)
Bachelor of Nutrition (RPL)
Bachelor of Hospital Administration (RPL)
Bachelor of Islamic Education
Bachelor of Islamic Elementary Education
Bachelor of Elementary Education
Bachelor of Mathematics Education
Bachelor of Islamic Education (RPL)
Bachelor of Islamic Elementary Education (RPL)
Bachelor of Elementary Education (RPL)
Bachelor of Mathematics Education (RPL)
Bachelor of Islamic Banking
Bachelor of Islamic Economics
Bachelor of Accounting
Bachelor of Management
Bachelor of Islamic Banking (RPL)
Bachelor of Islamic Economics (RPL)
Bachelor of Accounting (RPL)
Bachelor of Management (RPL)
Bachelor of Information System
Bachelor of Informatics
Bachelor of Information System (RPL)
Bachelor of Informatics (RPL)
I certify that the statements I have made in response to the foregoing questions are true, completed and correct to the best of my knowledge.
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