undergraduate admission others
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7/30/2019 Undergraduate Admission Others
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FORMS
GUNTINGD
ISINI
FORM RECEIPTACADEMIC YEAR 2013/2014
FORM RECEIPTACADEMIC YEAR 2013/2014
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3 x4
STUDENTS INFORMATION
Application Number :
Full Name :
High School (HS) :
HS City, Province :
HS Major : Science Social OthersHS Curriculum : National A/AS Level IB Others........................................
Phone :
Mobile Phone :
ENTRY OPTION
Direct Admission Direct Admission & Scholarship (only 1 preffered major) Admission Test Admission Test & Scholarship (only 1 preffered major)PREFERENCEMAJOR(See Table 2)
1st Major : Code Major
2nd Major : Code Major
3rd Major : Code Major
Copy 2 : UPH Admission Center
STUDENTS INFORMATION
Application Number :
Full Name :
ENTRY OPTION
Direct Admission Direct Admission & Scholarship (only 1 preffered major)
Admission Test Admission Test & Scholarship (only 1 preffered major)
PREFERENCEMAJOR(See Table 2)
1st Major : Code Major
2nd Major : Code Major
3rd Major : Code Major
Copy 1 : Prospective Student
To be submitted
1. ............................................................... 4. .................................................................
2. ............................................................... 5. .................................................................
3. ............................................................... 6. .................................................................
Parcipant Number
+ - - (country code - area code - phone)
+ - - (country code - area code - phone)
_______________ , _______________PLACE DATE
________________________________ADMISSION STAFF'S SIGNATURE & FULL NAME
_______________ , _______________PLACE DATE
________________________________ADMISSION STAFF'S SIGNATURE & FULL NAME
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FORMS
ADMISSION STATEMENTACADEMIC YEAR 2013/2014
Major Code - -
Copy 2 : UPH Admission Center
This Admission Statement is an agreement between Prospective Student and UPH as an institution
READ CAREFULLY BEFORE YOU SIGN!
GUNTINGD
ISINI
_______________ , _______________PLACE DATE
Stamp Duty / Materai Rp. 6000
_________________________________ ___________________________________
PARENT/GUARDIANS FULL NAME & SIGNATURE PROSPECTIVE STUDENTS SIGNATURE & FULL NAMEPlease sign on the stamp/Harap tanda tangan mengenai materai.
Hereby afrm that: Dengan ini menegaskan bahwa:
1. I will not engage 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.
1. 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 blinded (for Medicine & Design Major) 2. Tidak buta warna (khusus jurusan: FK & FDTP)
3. I am willing to participate in a blood/urine examination at any
given time by UPH/STPPH.
3. 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.
4. Mengetahui bahwa penyelenggaraan pendidikan di UPH/
STPPH bercirikan iman Kristiani dan berdasarkan Pancasila &
UUD 1945
5. I am ready to be dismissed from UPH/STPPH if at the end of
the rst 4 semesters I have not yet at least 40 credits and have a
GPA