MESSAGE FROM THE RECTOR

MESSAGE FROM THE RECTOR

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

Lippo Village, February 24th, 2015

Welcome to UPH Global Campus,

world-class facilities, technology, and infrastructure. UPH also

Selamat datang di UPH Global Campus,

prepares students to be globally respected and appreciated by modern industries and businesses.

This Admission Manual Book has been prepared to provide

UPH berkomitmen memberi Anda pelayanan terbaik dengan

you with comprehensive information regarding UPH

menyediakan pendidikan holistik dengan kualitas internasional,

Undergraduate Programs and enrollment procedures.

fasilitas, teknologi serta infrastruktur kelas dunia.

Buku Petunjuk Pendaftaran ini dipersiapkan untuk memberikan

UPH juga mempersiapkan mahasiswa agar dapat diakui secara

informasi menyeluruh mengenai Program Sarjana Strata 1 dan

global dan diapresisasi oleh industri dan bisnis modern.

prosedur penerimaan mahasiswa baru. We welcome you to UPH Global Campus in Indonesia We are eager to have you in the UPH family and introduce you

where learning is fun and excellent holistic education

to the vision of our university, which is: True Knowledge, Faith

is open to you.

in Christ, and Godly Character.

Selamat datang di UPH Global Campus, dimana kami

Kami ingin Anda dapat bergabung dengan kami dan

menyediakan proses pembelajaran yang menyenangkan

memperkenalkan Anda tentang visi UPH, yaitu: True

melalui pendidikan holistik terbaik di Indonesia.

Knowledge, Faith in Christ, dan Godly Character. I pray that God will richly bless you during your study at UPH. UPH is committed to serve you in the best possible ways, by

Saya berdoa agar Tuhan selalu memberkati Anda selama

providing a holistic and internationally qualified education, and

masa kuliah Anda di UPH.

UPH Online Admission Manual • Academic Year 2016/2017

i

TABLE OF CONTENT

ii

Message from The Rector

i

Table of Content

ii

Online Admission Process

1

Important Notes

2

Admission & Scholarship Schedule

3

Undergraduate Program

4

Admission Requirements

5

Additional Requirements for Scholarship

6

Admission Test Regulations

7

Admission Statement

9

Scholarship Application Form

11

Art & Sport Scholarship Recommendation Form

12

Medical School Form

13

Health Declaration Form

14

Conservatory of Music Application Form

15

Conservatory of Music Recommendation Form

16

Full-English Class Application Form

17

Psychology Program Application Form

19



Submit details & send required documents

Fill application details

Receive Form Number

Online Application Payment

Register Account Link: http://online-admission.uph.edu

Regular Admission

Scholarship Admission

Admission Test (Medical School ONLY)

Direct Admission

Admission Test (Medical School, Homeschooling & PKBM)

Direct Admission

Selection Result

Failed

Passed

Interview

Regular Admission Result

Scholarship Result

Failed

Passed

Passed

Offering Letter

Join UPH Festival as a New student

UPH Festival

Complete Re-registration Form and submit to ADAK Bureau at building A, 3rd fl., July 1-31 August, 2016, 07.30 - 16.00 WIB

Submit Re-Registration Form

Submit Uniform Fitting Form & photo for UPH Smartcard E-mailed by [email protected]

Payment Process Based on the offering letter

ONLINE ADMISSION PROCESS

01

IMPORTANT NOTES

Application will be processed if the data and documents have met the requirements and been accepted by UPH. Aplikasi akan diproses apabila data dan dokumen sudah diterima lengkap oleh UPH.

Completed application will be processed within 14 working days. Aplikasi yang sudah lengkap akan diproses dalam jangka waktu 14 hari kerja.

Admission result will be announced by 2 (two) methods: Hasil akan diumumkan melalui 2(dua) metode:

1ST METHOD | METODE 1 Offering Letter sent to applicant’s address.

Offering Letter dikirimkan ke alamat calon mahasiswa

2ND METHOD | METODE 2 Offering Letter posted on Online Admission Website 1. Login to the following link: http://online-admission.uph.edu 2. Choose Admission Result to see OFFERING LETTER

Offering Letter ditampilkan di website pendaftaran online 1. Login ke link berikut ini: http://online-admission.uph.edu 2. Pilih hasil pendaftaran untuk melihat OFFERING LETTER

To complete application process please proceed the payment in accordance to Offering Letter. E-payment procedure is available on http://uph.edu/prospective-students.html. Untuk menyelesaikan proses pendaftaran silahkan lakukan pembayaran sesuai dengan Offering Letter. Prosedur e-payment tersedia di http://uph.edu/prospective-students.html. FORM NUMBER IS REQUIRED TO PROCEED THE PAYMENT. PLEASE FIND YOUR FORM NUMBER IN YOUR OFFERING LETTER.

FORM NUMBER

NOMOR FORMULIR DIBUTUHKAN UNTUK MELAKUKAN PEMBAYARAN. NOMOR FORMULIR DAPAT DITEMUKAN DALAM OFFERING LETTER ANDA.

NOMOR FORMULIR

If you need more detailed information, please contact us through: Apabila anda memerlukan informasi yang lebih detail, dapat menghubungi kami melalui: UPH GLOBAL CAMPUS Jl. M.H. Thamrin Boulevard 1100 Lippo Village Tangerang 15811 – Indonesia (021) 5470901 (021) 5460910 [email protected] www.uph.edu @uphkonsultasi

02


ADMISSION & SCHOLARSHIP SCHEDULE ADMISSION SCHEDULE 2016/2017 ALL MAJORS EXCEPT MEDICINE SUBMISSION DEADLINE

ADMISSION TEST

Early Admission 1

23 SEPT 2015

10 OCT 2015

Early Admission 2

13 NOV 2015

28 NOV 2015

Outside Jabodetabek

13 NOV 2015

28 NOV 2015

Term 1

15 JAN 2016

30 JAN 2016

Term 2

04 MAR 2016

19 MAR 2016

Term 3

29 APR 2016

13 MAY 2016

Term 4

01 JUL 2016

15 JUL 2016

SUBMISSION DEADLINE

ADMISSION TEST

MEDICINE

Early Admission 1

07 OCT 2015

10 OCT 2015

Early Admission 2

25 NOV 2015

28 NOV 2015

Outside Jabodetabek

25 NOV 2015

28 NOV 2015

Term 1

27 JAN 2016

30 JAN 2016

Term 3

10 MAY 2016

13 MAY 2016

SCHOLARSHIP SCHEDULE 2016/2017 ALL MAJORS EXCEPT MEDICINE SUBMISSION DEADLINE

ADMISSION TEST

INTERVIEW SESSION

ANNOUNCEMENT

Best Student

28 AUG 2015

-

31 AUG - 11 SEPT 2015

28 SEPT 2015

Term 1

11 SEPT 2015

-

14 SEPT - 02 OCT 2015

19 OCT 2015

Term 2

30 0CT 2015

-

02 - 13 NOV 2015

30 NOV 2015

SUBMISSION DEADLINE

ADMISSION TEST

INTERVIEW SESSION

ANNOUNCEMENT

Term 1

28 AUG 2015

05 SEPT 2015

TBA

12 OCT 2015

Term 2

15 JAN 2016

30 JAN 2016

TBA

14 MAR 2016

MEDICINE

Schedule may be subject to change, latest info please check www.uph.edu


03

UNDERGRADUATE PROGRAM 1. Double Degree and Dual Degree Programmes are listed based on information by May 2015. 2. Prospective Students are not required to choose Double Degree or Dual Degree in the first year. These programmes are subject to rules and regulations applied. 3. Prospective Students must decide and choose Joint Degree from the first term and complete 2 (two) application package (UPH & RMIT Application).

MAJOR

FULL ENGLISH CLASS

DOUBLE DEGREE

Management

ü

Computer Technology Applied Mathematics

ü

IPA & IPS

Accounting

ü

Information Systems

ü

IPA & IPS

Applied Communication Sciences*

ü

-

-

IPA & IPS

Government and Global Affairs

ü

-

-

IPA & IPS

Political Science

-

-

-

IPA & IPS

Law

ü

-

-

IPA & IPS

Architecture

-

-

-

IPA & IPS

Visual Communication Design

-

-

-

IPA & IPS

Interior Design

-

-

-

IPA & IPS

Product Design

-

-

-

IPA & IPS

Applied Mathematics

-

Informatics Management

-

IPA

Biotechnology

-

-

-

IPA

Electrical Engineering

-

-

-

IPA

Industrial Engineering

-

-

-

IPA & IPS

Civil Engineering

-

-

-

IPA

Food Technology

ü

-

ü

IPA

Information System

-

Accounting

-

IPA & IPS

Informatics

-

Applied Mathematics

-

IPA & IPS

Computer Technology

-

Management

-

IPA & IPS

Faculty of Psychology

Psychology

-

-

-

IPA & IPS

Conservatory of Music

Music

-

-

-

IPA & IPS

Medical School

Medicine

-

-

-

IPA

Hospitality Management

ü

-

ü

IPA & IPS

Travel Industry Management

-

-

-

IPA & IPS

School of Philosophy & Divinity

Philosophy

-

-

-

IPA & IPS

Faculty of Nursing and Apllied Health Sciences**

Nursing

-

-

-

IPA & IPS

Faculty of Education -Teachers College**

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

ü***

-

-

IPA & IPS

FACULTY

Business School

Faculty of Social and Political Sciences

School of Law

School of Design

Faculty of Science and Technology

Faculty of Computer Science

School of Hospitality and Tourism

* Available also in Online Learning ** For admission requirements and further information, please call : • Faculty of Nursing : (021) 546 0901 ext. 3437 • Teachers College : (021) 546 6057 ext. 2613/2637

04

DUAL/JOINT HIGH SCHOOL DEGREE MAJOR

*** Only for English Education


ADMISSION REQUIREMENTS COMPULSORY REQUIREMENTS FOR ALL MAJORS NO

DOCUMENTS

National Curriculum

IGCSE O Level

IGCSE A/AS Level

International Baccalaureate

Others

1

Admission Statement (see page 9)

ü

ü

ü

ü

ü

2

Stamp duty Rp.6000,- (put on Admission Statement page 9)

ü

ü

ü

ü

ü

3

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)

ü

ü

ü

ü

ü

4

A legalized copy of Academic Records : Grade 10 and 11

ü

ü

ü

ü

ü

5

Full-English Classes Application Form (see page 17)

ü

ü

ü

ü

ü

6

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

ü

ü

ü

ü

ü

7

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

ü

ü

ü

ü

ü

8

A legalized copy of O Level/A Level/AS Level IGCSE Report/Certificate (min 5 subject)

ü

ü

9

A legalized copy of IB Predicted

ü

ADDITIONAL REQUIREMENTS FOR SCHOOL OF DESIGN DOCUMENTS

NO 1

One page Essay: “Why I Choose X Major Study Program”

2

Color Blindness Test Certificate by Ophthalmologist/Oculist

3

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

4

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

5

Product Design: 2 hand drawings with Media: A3-size Paper & Pencil. • Industry Based Design (gadget, home appliances, automotive, furniture, stationary, etc) • Handicraft based design (jewelry, furniture, etc). Both preferably an innovation, complete with the uniqueness explanation.

6

Interior Design: For portfolio requirements, please see interior.sod.uph.edu

ADDITIONAL REQUIREMENTS FOR CONSERVATORY OF MUSIC DOCUMENTS

NO 1

Conservatory of Music Application Form & Conservatory of Music Recommendation Form (see page 17-18)

2

1 (one) video audition in WMA/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

ADDITIONAL REQUIREMENTS FOR MEDICAL SCHOOL DOCUMENTS

NO 1

Medical School Application Form & Health Declaration Form (see page 15-16)

2

Color Blindness Test Certificate by Ophthalmologist / Oculist

3

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.”

4

2 Recent Photo size 3x4 using white collared shirt with blue background

ADDITIONAL REQUIREMENTS FOR FACULTY OF PSYCHOLOGY DOCUMENTS

NO 1

Psychology Program Application Form (see page 19)


05

ADDITIONAL REQUIREMENTS FOR SCHOLARSHIP COMPULSORY REQUIREMENTS FOR ALL MAJORS NO

06

DOCUMENTS

Academic Achievement Category

Limited Financial Category

Art Achievement Category

Sport Achievement Category

1

Scholarship Application Form (see page 11)

ü

ü

ü

ü

2

Copy of Family Card/Kartu Keluarga

ü

ü

ü

ü

3

A-500-word English Essay about: “Why I Choose X Major at UPH as a Stepping Stone for My Career” (Except School of Design and Faculty of Medicine)

ü

ü

ü

ü

4

Copy of achievement certificate in any fields

ü

ü

ü

ü

5

A statement letter of family financial condition, issued by: Church (for Christian/Catholic) or RT/RW/Kelurahan (for other religions)

ü

6

Copy of electricity bill for the last 3 months

ü

7

Copy of water bill for the last 3 months

ü

8

Copy of landline telephone bill for the last 3 months

ü

9

Copy of the last Pajak Bumi dan Bangunan (PBB) payment

ü

10

Copy of Parent’s payslip of income

ü

11

Art & Sport Scholarship Recommendation Form (see page 12)

ü

ü

12

Recent photo (postcard size) using team uniform (write your name, height and weight behind the photo)

ü

13

Copy of sports certificate of performance (province/national/international level)

ü

14

Recommendation Letter from Komite Olahraga National Indonesia (KONI)

ü


ADMISSION TEST REGULATIONS BEFORE THE TEST 1. Participant is required to wear proper attire and shoes. 2. Participant is required to bring their own stationery (pen, 2B pencil, eraser, and calculator), Admission Test Participant Card and original ID card (KTP, driving license or other identification which has photograph of participant). Participant who does not bring the requirements must report to the Admission Test Committee. 3. Participant must be present in the test room 30 minutes before the test begin. Participant who is late is allowed to participate in the test without additional time. SEBELUM UJIAN BERLANGSUNG 1. Peserta wajib berpakaian rapi, sopan, dan bersepatu tertutup. 2. Peserta wajib membawa alat tulis (pena, pensil 2B, penghapus, dan kalkulator) milik sendiri, Kartu Tanda Peserta Ujian Saringan Masuk, dan kartu identitas asli (KTP, SIM atau identitas lainnya yang memuat pasfoto peserta). Peserta yang tidak membawa perlengkapan tersebut, wajib melapor kepada panitia Ujian Saringan Masuk. 3. Peserta wajib berada di ruang ujian 30 menit sebelum ujian dimulai. Peserta yang terlambat diperbolehkan mengikuti ujian tanpa ada penambahan waktu. DURING THE TEST 1. Participant is prohibited to interact with other participants. 2. Participant is not allowed to leave the test room without permission from the supervisor. 3. Participant should stop doing the test when there is a time up notification. 4. Breaking the Admission Test Regulations will cause participants a disqualification from the test and cancellation on the registration process. SELAMA UJIAN BERLANGSUNG 1. Peserta dilarang berinteraksi dengan peserta lain. 2. Peserta dilarang meninggalkan tempat ujian tanpa izin dari pengawas. 3. Peserta wajib menghentikan pekerjaannya setelah ada pemberitahuan bahwa waktu ujian telah berakhir. 4. Peserta akan dianggap gugur dan dibatalkan proses pendaftarannya jika melanggar tata tertib Ujian Saringan Masuk. IMPORTANT Participants must not cheat during the Admission Test under any conditions. If UPH finds out later that the participant has cheated on the test, then the participant will be terminated from UPH and no fees will be refunded. PENTING Peserta dilarang melakukan kecurangan saat Ujian Saringan Masuk. Apabila di kemudian hari diketahui bahwa mahasiswa aktif telah melakukan kecurangan saat ujian, mahasiswa yang bersangkutan akan dikeluarkan dari UPH tanpa ada pengembalian biaya kuliah yang telah dibayarkan.


07

ADMISSION STATEMENT Copy 1 : Admission Office

READ CAREFULLY BEFORE YOU SIGN! Bacalah dengan seksama sebelum Anda menandatangani! I, the undersigned: Saya yang bertanda tangan di bawah ini: Form Number Nomor Formulir

:

Full Name Nama Lengkap

:

Hereby affirm that, dengan ini menegaskan bahwa, 1. I understand that 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 dan UUD 1945 2. 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 at any given time by UPH/STPPH. 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 yang sewaktuwaktu akan dilakukan oleh pihak UPH/STPPH. 3. I am willing to participate in a blood/urine examination at any given time by UPH/STTPH. Bersedia melakukan tes darah/urine yang sewaktu-waktu akan dilakukan oleh pihak UPH/STTPH. 4. All documents that I submit are legal. I am fully responsible for any consequences and willing to accept all sanctions for any INCORRECT information. Semua dokumen yang dikumpulkan ke UPH adalah sah. Saya bersedia menanggung segala sanksi apabila informasi yang saya berikan TIDAK BENAR. 5. I am willing to accept sanctions (Drop Out) from UPH/STPPH unless I can submit the copy of High School Certificate or High School Certificate Equivalency before the end of 2nd term, even though the tuition fee has been paid. Bersedia menanggung sanksi (dikeluarkan) dari UPH/STPPH jika tidak dapat menyerahkan fotokopi ijazah SMA Nasional/Surat Penyetaraan Ijazah sebelum term 2 berakhir walaupun sudah diterima dan membayar uang kuliah. 6. 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 study in the next terms (2nd term). Untuk Fakultas Psikologi: Saya mengetahui dan menyetujui untuk mengikuti pembelajaran di Fakultas Psikologi UPH yang diperkaya dengan nilai-nilai Kristiani. Saya menyadari sepenuhnya bahwa akan ada konseling pribadi sebagai prasyarat untuk melanjutkan pembelajaran pada term berikutnya (term 2). 7. I understand that Double Degree and Dual Degree programmes will start after the first year of class. These programmes are subject to the applied rules and regulations . Saya mengerti bahwa program Double Degree dan Dual Degree akan dilaksanakan setelah tahun pertama perkuliahan, sehingga akan ada kemungkinan terjadi perubahan. 8. I understand that if the quota of a class is full, UPH has the right not to accept any payment although it is before payment deadline. Saya mengerti bahwa jika batas maksimum kapasitas jumlah mahasiswa yang dapat diterima sudah tercapai, maka UPH berhak menolak pembayaran yang akan dilakukan meskipun belum mencapai batas akhir pembayaran. 9. All payments transferred to Pelita Harapan Foundation are declared as the final decision, finalized by the depositor, can’t be refunded for any conditions.

10.

11. 12. 13.

Semua pembayaran yang telah disetor ke Yayasan Universitas Pelita Harapan dinyatakan sebagai keputusan akhir dari pihak penyetor dan tidak dapat ditarik kembali dengan alasan dan kondisi apapun. I along with my parents hereby acknowledged and confirmed our acceptance on the consequences of provisions number 9 as stated above and therefore we will not file any law suit in connection with provision number 9 above. Saya bersama dengan orang tua saya dengan ini menegaskan bahwa kami sudah mengerti dan menerima konsekuensi dari ketentuan point 9 di atas dan oleh karena itu kami tidak akan mengajukan gugatan hukum apapun di kemudian hari sehubungan dengan ketentuan nomor 9 tersebut di atas. All documents that I submit fully belong to UPH and UPH will not entertain requests to return the documents for any reason. Semua dokumen yang dikumpulkan sepenuhnya menjadi milik UPH dan tidak dapat dikembalikan dengan alasan apapun. I agree to abide by the Regulations stated by the University, both now and in the future. Bersedia mentaati Statuta, Peraturan Tata Tertib Kampus, dan peraturan lain yang telah dan akan diberlakukan. I have read, known, and understood the regulations and registration requirements stated in this Admission Manual. Telah membaca, mengetahui, mengerti ketentuan dan persyaratan pendaftaran dalam Buku Petunjuk Admisi ini.

, Place | Tempat

Date | Tanggal Stamp Duty/Materai Rp. 6000

potong disini

Please sign on the stamp duty/ Harap tanda tangan di atas materai

PARENT/GUARDIAN’S SIGNATURE & FULL NAME Tanda Tangan & Nama Lengkap Orang Tua/Wali


PROSPECTIVE STUDENT’S SIGNATURE & FULL NAME Tanda Tangan & Nama Lengkap Calon Mahasiswa

09

SCHOLARSHIP APPLICATION FORM SCHOLARSHIP APPLICATION FOR ALL CATEGORIES I, the undersigned: Saya yang bertanda tangan di bawah ini: Form Number Nomor Formulir

:


:

Social, Organizational or Leadership Activities Aktivitas sosial, organisasi atau kepimpinan Student Council

Spiritual Activities

Red Cross Youth Council

Martial Arts

Sport

Scout

Choir/Vocal Group

Flag-raising Squad

Band/Orchestra

Others,

Language Club Achievements (Senior High School Level) Penghargaan yang pernah diperoleh (di tingkat SMA)

(Please attach certificate that support this information) (Lampirkan fotokopi sertifikat sebagai bukti yang mendukung informasi ini)

Religious Activities at Church Aktivitas keagamaan di gereja

If you are Christian/Catholic, please fill the following information: Jika Anda beragama Kristen/Katolik, harap isi keterangan berikut ini:

Church : Nama Gereja Address : Alamat Gereja Join ministry/activities : Mengikuti kegiatan pelayanan Scholarship Category | Kategori Beasiswa

Please give tick (v) in your option | Silahkan berikan tanda (v) dalam pilihan Anda

Academic Achievement | Prestasi Akademik

Art Achievement | Prestasi Seni

Limited Finance | Kondisi Ekonomi Terbatas

Sport Achievement | Prestasi Olahraga

I certify that the above information is true and correct. Saya tegaskan informasi di atas adalah benar. , Place | Tempat

Date | Tanggal

potong disini

PROSPECTIVE STUDENT’S SIGNATURE & FULL NAME Tanda Tangan & Nama Lengkap Calon Mahasiswa


PARENT/GUARDIAN’S SIGNATURE & FULL NAME Tanda Tangan & Nama Lengkap Orang Tua/Wali

11

ART & SPORT SCHOLARSHIP RECOMMENDATION FORM SCHOLARSHIP APPLICATION FOR ART ACHIEVEMENT OR SPORT ACHIEVEMENT CATEGORY I, the undersigned: Saya yang bertanda tangan di bawah ini: Coach/Teacher Full Name Nama lengkap Pelatih/Guru

:

High School/Institution Name Nama Sekolah/Institusi

:

ART

Coach/Teacher of: Pelatih/Guru Guitar

Drum

Vocal

Acting

Bass

Piano

Modern Dance

Photography

Keyboard

Choir

Traditional Dance

Video Editing SPORT

Coach Pelatih Volleyball

Basketball

Soccer

Swimming

Badminton

Futsal

Please recommend this prospective student regarding his/her scholarship application: Mohon untuk merekomendasikan Calon Mahasiswa ini pada pendaftaran Program Beasiswa: Form Number : Nomor Formulir Full Name Nama Lengkap

:

Height Tinggi Badan

:

Position in Team Posisi pada Tim

cm

Weight Berat Badan

:

kg

: 1. __________________________ 2. __________________________ 3. __________________________

I certify that the above information is true and correct. Saya tegaskan informasi diatas adalah benar.

Coach/Teacher, Pelatih/Guru

, Place | Tempat

Date | Tanggal

Coach/Teacher’s Signature & Full Name + Stamp (if any) Tanda Tangan & Nama Lengkap Pelatih/Guru + Cap (jika ada)

12


MEDICAL SCHOOL FORM PROSPECTIVE STUDENT Form Number Nomor Formulir

:


:

Place & Date of Birth : Tempat & Tanggal Lahir Name of Parent Nama Orang Tua

:

Name of Family Doctor Nama Dokter Keluarga

:

COMMUNITY INVOLVEMENT Please provide a brief summary of all volunteering, caring, community leadership, religious services and organizations that you have participated in. Jelaskan secara singkat semua bentuk partisipasi Anda pada kegiatan relawan, kepemimpinan, pelayanan keagamaan dan organisasi.

PERSONAL ACHIEVEMENT Please provide a brief summary of your current sports, artistic activities, hobbies, and interests. Jelaskan secara singkat tentang kegiatan olahraga, seni, hobi, dan minat Anda saat ini.

Prospective Student, Calon Mahasiswa , Place | Tempat

Date | Tanggal

potong disini

Prospective Student’s Signature & Full Name Tanda Tangan & Nama Lengkap Calon Mahasiswa


13

HEALTH DECLARATION FORM If you are accepted as a student of the Medical School, 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 wajib 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.

I, the undersigned: Saya yang bertanda tangan di bawah ini: Full Name : Nama Lengkap HEALTH DECLARATION Pernyataan

No.

YES Ya

1

Do you have, or have you ever had, any medical conditions or operations in the past 5 years? Apakah Anda memiliki atau pernah memiliki kondisi medis tertentu atau pernah menjalani operasi dalam 5 tahun terakhir?

2

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 sedang akan menjalani perawatan medis, mengkonsumsi obat-obatan?

3

Do you have impairment/disability (physical or metal) or specific learning disability which may affect your ability to study in UPH Medical School? Apakah Anda memilki kekurangan/cacat (fisik atau mental) atau ketidakmampuan belajar yang dapat mempengaruhi proses belajar Anda di Fakultas Kedokteran UPH?

4

Have you ever suffered from tuberculosis (TB) within the past 12 months? Apakah Anda pernah menderita tuberkulosis (TB) dalam 12 bulan terakhir?

5

Has any family member or close contact been treated for TB? Apakah ada anggota keluarga atau orang di sekitar Anda yang pernah dirawat karena TBC?

6

Have you had a cough for more than 3 weeks? Apakah Anda menderita batuk lebih dari 3 minggu?

7

Have you coughed up blood? Apakah Anda pernah batuk berdarah?

8

Have you had any unexplained weight loss? Apakah Anda pernah kehilangan berat badan tanpa sebab yang dapat dijelaskan?

9

Have you suffered from night sweats or fever? Apakah Anda menderita demam atau keringat berlebih saat tidur?

10

Have you ever had any kind of back, joint or muscle problem? Apakah Anda mengalami sakit punggung, sendi atau masalah otot?

11

Have you ever had, Dermatitis, Eczema, Psoriasis or any other skin condition? Apakah Anda pernah mengalami: Dermatitis, Eksim, Psoriasis atau penyakit kulit lainnya?

12

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 berpotensi mempengaruhi kemampuan Anda dalam belajar dan mempraktekkan ilmu medis?

13

Have you ever had a drug, tobacco, nicotine or alcohol problem? Apakah Anda pernah memiliki masalah yang terkait dengan narkoba, tembakau, nikotin atau alkohol?

14

Do you have any difficulty with your eyesight, including color blindess? Apakah Anda memiliki kesulitan dengan penglihatan Anda, termasuk buta warna?

15

Do you have difficulty in hearing? Apakah Anda memiliki kesulitan pendengaran?

16

Have you ever suffered from any of the following: loss of consciousness including fainting attacks, blackouts or epilepsy? Pernahkah Anda menderita kehilangan kesadaran termasuk pingsan atau pingsan karena epilepsi

17

Have you ever suffered from any of the following: heart disease, diabetes, Hypertension or any other medical illness? Pernahkah Anda pernah mengalami; penyakit jantung, diabetes, Hipertensi atau penyakit medis lainnya?

18

Have you ever suffered from chest or lung problems: Asthma, Bronchitis? Apakah Anda pernah mengalami masalah paru-paru: Asma, atau Bronkitis?

19

Have you ever had any allergies, including to drugs, food or latex? Pernahkah Anda punya alergi, termasuk alergi terhadap obat-obatan, makanan atau lateks?

20

Have you ever received treatment for bowel or gastric problems? Apakah Anda menerima perawatan karena masalah usus atau lambung?

21

Do you have any other medical conditions not previously mentioned in questions 1 – 15 above? Apakah Anda pernah mengalami masalah kesehatan lainnya yang tidak disebutkan pada pertanyaan 1 – 15?

22

Have you been vaccinated for Hepatitis? If you have, what was the dosage? Apakah Anda pernah mendapat vaksin Hepatitis? Jika ya, berapa dosisnya?

23

Have you had any episode of Jaundice/Hepatitis? If yes, please submit the Laboratory Blood Report. If you already committed, you have to submit the Laboratory Blood Report to FK Admission Office, FK Building 2nd fl, on August 1-10, 2016 during weekdays. Apakah Anda pernah menderita Hepatitis? Jika ya, harap mengirimkan Hasil Periksa Darah dari laboratorium ke kantor Administrasi FK, Gedung FK lt.2, pada tanggal 1-10 Agustus 2016 di hari kerja.

I certify that the above information is true and correct. Saya tegaskan informasi diatas adalah benar.

Medical School New Student, Mahasiswa Baru Fakultas Kedokteran

Place | Tempat

Signature & Full Name

Date | Tanggal

NO Tidak

DETAILS Keterangan

Tanda Tangan & Nama Lengkap

14


CONSERVATORY OF MUSIC APPLICATION FORM NOTES

1. Complete the Student Information form. 2. Check the admission requirement and procedure at www.music.uph.edu 3. Applicants for all concentrations have to submit a good quality DVD/VCD recording which contains three contrasting pieces. 4. Applicants may be asked to take a Music Placement Test (Music Theory and Solfeggio). 5. The Recommendation form (p.16) must be completed by the referee.

Form Number Nomor Formulir

:


:

High School Name Nama Sekolah

:

Preferred Consentration (Put Rank 1st, 2nd, and 3rd based on priority) Konsentrasi Pilihan (Pilih berdasarkan prioritas 1, 2, dan 3)

Arts Management

Jazz and Pop Performance

Church Music

Preferred major instrument: (Please tick one only) Instrumen Pilihan: (Pilih salah satu) Non-classical Instrument

Classical Instrument Piano

Clarinet

Music Education

Vocal

Bassoon

Vocal

Guitar

French-Horn

Electric Guitar

Classical Performance

Music Therapy

Violin

Trumpet

Electric Bass

Viola

Trombone

Drum

Composition

Sound Design

Cello

Tuba

Saxophone

Contra-Bass

Percussion

Flute

Harp

Oboe

Piano

Why did you choose UPH Conservatory of Music? Describe. Mengapa Anda memilih Conservatory of Music UPH? Jelaskan.

How does music impact your life? Bagaimana musik memberi dampak bagi hidup Anda?

Why did you choose your 1st choice consentration? Mengapa Anda memilih pilihan konsentrasi pertama?

Who is your favorite composer or performer? Why? Siapa komposer/performer favorit Anda? Mengapa?

Why did you choose your 2nd choice consentration? Mengapa Anda memilih pilihan konsentrasi kedua?

Ensemble playing experience: Yes/No Apakah Anda pernah memainkan ensemble: Ya/Tidak

Why did you choose your 3rd choice consentration? Mengapa Anda memilih pilihan konsentrasi ketiga?

Did you apply to a Conservatory of Music other than UPH? Yes/No Apakah Anda mendaftar ke jurusan Musik selain di UPH? Ya/Tidak

Mention the repertoire that you have learned! Sebutkan repertoire yang pernah Anda pelajari!

Recent teacher name: _______________________________ Institution/music schools: ___________________________ Music award ever received (if any): ____________________

Briefly, describe your goals and what influence you to plan a career in music. Jelaskan secara singkat mengenai tujuan dan dampak yang Anda dapat berikan saat berkarir di bidang musik.

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CONSERVATORY OF MUSIC RECOMMENDATION FORM REFEREE | PEMBERI REKOMENDASI Full Name Nama Lengkap

:

Institution/School of Music : Nama Sekolah Musik Phone Number Nomor Telepon

:

Mobile Phone Nomor Handphone

:

Length of Courses Lama Belajar

:

Year Tahun

Frequency/week : Frekuensi/minggu

Hours/Course : Jam/Kelas

Please circle the most appropriate answer based on prospective student’s music skill. Silahkan lingkari pilihan yang sesuai dengan opini Anda mengenai keterampilan musik Calon Mahasiswa berdasarkan keterampilan musik calon mahasiswa 1. Technical strength in playing the instrument: a. Solid b. Need supervision to be solid c. Difficult to be solid

6. Level of diligence 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

2. Musical strength in playing the instrument: a. Sensitive and able to perform an outstanding musical showing diligence to do the work b. sensitive yet need guidance c. less sensitive

7. Level of speed to grasp knowledge a. Shows rapid development in a short amount of time b. Not too fast in showing diligence to do the work ability by his/her own intitative c. Not too fast and less careful over the given correction not too fast and less careful over the given correction

3. Knowledge of Theory of Music a. Very Good in making harmony using S-A-T-B format b. Know basic format in writing S-A-T-B c. Doesn’t have a deep knowledge in theory of music

8. Your opinion about the maturity of your student a. Mature b. Quite mature c. Immature

4. Knowledge about aural training a. Well trained in soffegio/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

9. Level of confidence to see your student will be able to succeed studying at UPH Conservatory of Music with his/her chosen rhythmic dictation, melody, interval, and harmony concentration a. Very sure 80%-100% b. Sure 60%-80% c. Unsure 50%-60%

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 received any guidance

10. Your consideration for the student to get scholarship a. Highly recommended b. Recommended c. Less recommended

REFEREE COMMENTS REGARDING SCHOLARSHIP APPLICANT | KOMENTAR PEMBERI REKOMENDASI MENGENAI PEMOHON

Referee, Pemberi Rekomendasi I certify that the above information is true and correct. Saya tegaskan informasi diatas adalah benar.

, Place | Tempat

Date | Tanggal

Referee’s Signature & Full Name + Stamp (if any) Tanda Tangan & Nama Lengkap Pemberi Rekomendasi + Cap (jika ada)

16


FULL-ENGLISH CLASSES APPLICATION FORM PROSPECTIVE STUDENT WHO APPLY TO FULL ENGLISH CLASS IS REQUIRED TO FILL THIS FORM Form Number

:

Full Name

:

Major

:

Phone Number

:

E-mail Address

:

Mobile Number :

I will submit TOEFL/IELTS score by: Take TOEFL Test at UPH Language Center. Please check the update schedule at www.uph.edu (Info Center). Submit a copy of TOEFL/IELTS Certificate (Submission deadline: June 26, 2015) * we accept only TOEFL/IELTS results from LIA, AMINEF, TOEFL/IELTS International

1. This form is required ONLY for Prospective Student who apply to the available Full English Class as listed below: - Management - Accounting - Communication - International Relation - Law - Food Technology - Hospitality Management

REQUIREMENTS

2. Prospective Students must submit a copy of valid certificate of TOEFL/IELTS. 3. The minimum score to apply Full English Class: TOEFL Paper Based Test : 500 TOEFL Internet Based Test : 59 – 60 IELTS : 5.0 If the requirement above can not be fulfilled, the Prospective Students could not apply Full English Class. 4. Full English Class has limited seats. All applications will be processed and selected by UPH. The Final decision could be ACCEPTED or NOT, and is an absolute decision.

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____________, __________________ Place Date

Received by,

Verified by,

( ___________________________________ ) Prospective Student’s Signature & Full Name

( ___________________________________ ) Admission Staff’s Signature & Full Name

( ___________________________________ ) UPH Language Center’s Signature & Full Name


17

16

UPH Admission Manual • Academic Year 2015/2016

PSYCHOLOGY PROGRAM APPLICATION FORM PSYCHOLOGY PROGRAM I, the undersigned: Saya yang bertanda tangan di bawah ini: Form Number Nomor Formulir

:


:

Phone/Mobile Number Nomor Telepon

:

E-mail address Alamat E-mail

:

Preferred Concentration | Konsentrasi Pilihan

Please give tick (v) in your option | Silahkan berikan tanda (v) dalam pilihan Anda

Psychology | Psikologi Psychology & Entreprenurship | Psikologi & Kewirausahaan

I certify that the above information is true and correct.

Saya tegaskan informasi diatas adalah benar.

, Place | Tempat

Date | Tanggal

Prospective Student’s Signature & Full Name Tanda Tangan & Nama Lengkap Calon Mahasiswa

Parent/Guardian’s Signature & Full Name Tanda Tangan & Nama Lengkap Orang Tua/Wali

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MESSAGE FROM THE RECTOR

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