Admission Manual

MESSAGE
FROM
THE RECTOR
Lippo Village, March 18th, 2016
Dr. (Hon) Jonathan L. Parapak, M.Eng.Sc

Chancellor / Rector
Welcome to UPH Global Campus,
Selamat datang di UPH Global Campus,
This Admission Manual has been prepared to
Buku Petunjuk Pendaftaran ini dipersiapkan untuk memberikan
provide you with comprehensive information regarding
informasi menyeluruh mengenai Program Sarjana Strata 1 dan
UPH Undergraduate Programs and enrollment procedures.
prosedur penerimaan mahasiswa baru.
We welcome you to the UPH family and would like to introduce
Kami menyambut Anda sebagai bagian dari Keluarga UPH dan
you to the vision of our university: True Knowledge, Faith in
memperkenalkan Anda tentang visi UPH, yaitu: Pengetahuan
Christ, and Godly Character.
Sejati, Iman Dalam Kristus, dan Karakter Ilahi.
UPH is committed to serving you in the best possible ways, by
UPH berkomitmen memberi Anda pelayanan terbaik dengan
providing holistic and internationally recognized education, world-
menyediakan pendidikan holistis berkualitas internasional, didukung
class facilities, technology, and infrastructure. UPH also prepares
fasilitas, teknologi serta infrastruktur kelas dunia.
students to be globally informed and appreciated by multi-national
UPH juga mempersiapkan mahasiswa agar dapat diakui secara global
industries and businesses.
dan diapresisasi oleh industri dan bisnis modern.
We welcome you to the UPH Global Campus in Indonesia
Selamat datang di UPH Global Campus, dimana kami
where learning is dinamic within an excellent holistic
menyediakan proses pembelajaran yang dinamis melalui
educational environment.
lingkungan pendidikan holistis yang terbaik di Indonesia.
I pray that God will richly bless you during your study at UPH.
Saya berdoa kiranya Tuhan selalu memberkati Anda selama masa

kuliah Anda di UPH.
i
Contents
ii
Message from The Rector
Table of Content
ii
Admission Process
Important Notes
Admission & Scholarship Schedule
Undergraduate Program
Admission Requirements
Additional Requirements for Scholarship
Admission Test Regulations
Receipt Form
Admission Statement
11
Drug Free Statement
13
Scholarship Application Form
15
Art & Sport Scholarship Recommendation Form
16
School of Design Application Form
17
Conservatory of Music Application Form
19
Conservatory of Music Recommendation Form
20
Faculty of Medicine Application Form
21
Health Declaration Form
22
Faculty of Psychology Application Form
23
School of Phylosophy and Divinity Application Form
24
Full-English Class Application Form
25
New Student Re-Registration Form
27
New Student Data Form
28
Admission Statement (Prospective Student)
29
Admission Process
Submit
Application
Form
Scholarship
Admission
Admission Test
(Medicine ONLY)
Direct
Admission
Passed
Regular
Admission
Direct
Admission
Selection
Result
Admission Test
(Medicine, Homeschooling & PKBM)
Regular
Admission
Result
Failed
Failed
Interview
Scholarship
Result
Failed
(Failed Scholarship, Accepted Reguler)
Offering
Letter
Passed
Passed
Payment Process
Based on the offering letter
Submit Uniform
Fitting Form & photo
for UPH Smartcard
e-mailed by bma@uph.edu
Submit Re-Registration Form

Complete Re-registration Form
(Page 27-28) and submit to
ADAK Directorate at building A,
3rd fl., July 1-31 August, 2017,
07.30 - 16.00 WIB
UPH Festival
Join UPH Festival as a New student
Important Notes
Application will be processed if the form and documents have met the requirements
and been accepted by UPH.
Formulir akan diproses apabila formulir dan dokumen sudah diterima lengkap oleh UPH.
Completed form will be processed within 14 working days.

Formulir 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 applicants e-mail address.
Offering Letter dikirimkan ke alamat email calon mahasiswa
2ND METHOD | METODE 2

Offering Letter posted on Online Admission Website
1. Login to the following link:
www.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:
www.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
17xxxxxxxx
NOMOR FORMULIR DIBUTUHKAN UNTUK MELAKUKAN PEMBAYARAN. NOMOR

FORMULIR DAPAT DITEMUKAN DALAM OFFERING LETTER ANDA.
NOMOR FORMULIR
17xxxxxxxx
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
undergraduate.admission@uph.edu
www.uph.edu
@uphkonsultasi
Admission Scholarship and Schedule

ADMISSION SCHEDULE 2017/2018
ALL MAJORS EXCEPT MEDICINE
SUBMISSION DEADLINE
ADMISSION TEST
Early Admission 1
23 SEPT 2016
08 OCT 2016
Early Admission 2
11 NOV 2016
26 NOV 2016
Outside Jabodetabek
11 NOV 2016
26 NOV 2016
Term 1
20 JAN 2017
04 FEB 2017
Term 2
03 MAR 2017
25 MAR 2017
Term 3
05 MAY 2017
19 MAY 2017
Term 4
23 JUN 2017
14 JUL 2017
SUBMISSION DEADLINE
ADMISSION TEST
MEDICINE
Early Admission 1
05 OCT 2016
08 OCT 2016
Early Admission 2
23 NOV 2016
26 NOV 2016
Outside Jabodetabek
23 NOV 2016
26 NOV 2016
Term 1
01 FEB 2017
04 FEB 2017
Term 3
16 MAY 2017
19 MAY 2017
SCHOLARSHIP SCHEDULE 2017/2018

ALL MAJORS EXCEPT MEDICINE
SUBMISSION DEADLINE
ADMISSION TEST
INTERVIEW SESSION
ANNOUNCEMENT
Best Student
20 AUG 2016
22 AUG - 02 SEPT 2016
19 SEPT 2016
Term 1
09 SEPT 2016
13 - 30 SEPT 2016
17 OCT 2016
11 NOV 2016
14 NOV - 25 NOV 2016
02 DEC 2016
SUBMISSION DEADLINE
ADMISSION TEST
INTERVIEW SESSION
ANNOUNCEMENT
02 SEPT 2016
10 SEPT 2016
TBA
17 OCT 2016
27 JAN 2017
04 FEB 2017
TBA
13 MAR 2017
Term 2
MEDICINE
Term 1
Term 2
Schedule may be subject to change, latest info please check www.uph.edu
Undergraduate Program
FACULTY
Business School
Faculty of Social and

Political Sciences
School of Law
School of Design
MAJOR
FULL ENGLISH
CLASS
Management
Accounting
Applied Communication Science*

International relations
Political Science
INTERNATIONAL
CLASS
DOUBLE/DUAL/
JOINT DEGREE
HIGH
SCHOOL MAJOR
Joint Degree
IPA & IPS
Joint Degree
IPA & IPS
IPA & IPS
IPA & IPS
IPA & IPS
IPA & IPS
Architecture
IPA & IPS
Visual Communication Design
IPA & IPS
Interior Design
IPA & IPS
Law
Product Design
Applied Mathematics
IPA & IPS
Double Degree
IPA
Biotechnology
IPA
Faculty of Science
Electrical Engineering
IPA
and Technology
Industrial Engineering
IPA
Civil Engineering
IPA
Dual Degree
IPA
Information System
IPA & IPS
Food Technology
Faculty of
Informatics
IPA & IPS
Computer Technology
IPA & IPS
Psychology
IPA & IPS
Music
IPA & IPS
Faculty of Medicine
Medicine
IPA
School of Hospitality
and Tourism
Hospitality Management
Dual Degree
IPA & IPS
Computer Science
Faculty of
Psychology
Conservatory
of Music
Travel Industry Management
IPA & IPS
School of Philosophy
& Divinity
Philosophy
IPA & IPS
Faculty of Nursing
and Apllied Health
Sciences**
Nursing
IPA & IPS
Biology Education
IPA
Economic Education
IPA & IPS
Joint Degree
IPA & IPS
English Education
Faculty of Education
-Teachers College**
Mathematics Education
IPA & IPS
Primary Education
Joint Degree
IPA & IPS
Chemistry Education
IPA
Physics Education
IPA
Christian Religion Education
IPA & IPS
Notes:
1. Double Degree and Dual Degree Programmes are listed based on information.
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 and International Class from the first term.
4. For Business School Joint Degree must complete 2 (two) application package (UPH & RMIT Application).
* Online Learning also available.
** For admission requirements and further information, please call:
Faculty of Nursing: (021) 546 0901 ext. 3437 Teachers College: (021) 546 6057 ext. 2613/2637 Joint Degree Teachers College: (021) 546 0901 ext. 2257
Admission Requirements
IMPORTANT!
All prospective students have to be graduated or on progress to graduate from year 12 / from education equivalent to year 12 level.
Semua calon mahasiswa yang mendaftar di UPH wajib telah menyelesaikan atau sedang menempuh pendidikan di kelas 12 / sederajat.
Compulsory Requirements For All Majors

NO
DOCUMENT
Admission Statement (see page 11)
Drug Free Statement (see page 13)
A Legalized copy of Junior High School National Examination/UN SMP, Academic Records: Grade 10 and 11 (Last 3 years of academic record)
A Copy of Valid ID Card (KTP/Kartu Pelajar/SIM/Passport)
Full-English Classes Application Form (only for selected majors - see page 25)
A copy of TOEFL IBT/IELTS Certificate with minimum score 71 for TOEFL IBT or 5.5 for IELTS (Only for Foreign Student)
Additional Requirements
NO
MAJOR
Business School International

Program (Int. Class & Joint Degree)
DOCUMENT
A copy of TOEFL IBT/IELTS Certificate with minimum score 71 for TOEFL IBT or 5.5 for IELTS
School of Design
School of Design application form (see page 17)
Conservatory of Music
Conservatory of Music Application Form & Conservatory of Music Recommendation Form (see page 19-20)
Faculty of Medicine
Medical School Application Form & Health Declaration Form (see page 21-22)
Faculty of Psychology
Faculty of Psychology Application Form (see page 23)
Philopsophy
School of Philosophy and Divinity Application Form (see page 24)
During Re-Registration
ONLY FOR INDONESIAN STUDENT (WNI)
SENIOR HIGH SCHOOL CATEGORY

National Curriculum
International Curriculum in Indonesia (SPK)
Non-Formal Education (PKBM)
Informal Education (Homeschooling)
Overseas School
FINAL CERTIFICATE
High School Certificate & SHUN
PAKET C
Letter of Equivalency
ONLY FOR FOREIGN STUDENT (WNA)
NO
DOCUMENT
Foreigner Study Permit Issued by Ministry of Education and Culture RI
The Indonesian Limited Stay Permit Card
Additional Requirements For Scholarship
NO
DOCUMENT
ACADEMIC
ACHIEVEMENT
LIMITED
FINANCIAL
ART
ACHIEVEMENT
SPORT
ACHIEVEMENT
Scholarship Application Form (see page 15)
Copy of Family Card/Kartu Keluarga
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)
Copy of Achievement Certificate in any fields
A statement letter of family financial condition, issued by: Church

(for Christian/Catholic) or RT/RW/Kelurahan (for other religions)
Copy of Electricity bill for the last 3 months
Copy of water bill for the last 3 months
Copy of landline telephone bill for the last 3 months
Copy of the last Pajak Bumi dan Bangunan (PBB) payment
10
Copy of Parents payslip of income
11
Art & Sport Scholarship Recommendation Form (see page 16)
12
Recent photo (postcard size) using team uniform

(write your name, height and weight behind the photo)
13
Copy of Sports Certificate of Performance

(province/national/international level)
14
Recommendation Letter from Komite Olahraga National Indonesia (KONI)
15
Copy of Arts Certificate of Performance

(province/national/international level)
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 must stop doing the test when there is a time up notification.
4. Participants will be disqualified and their registration process will be cancelled should they breach any of the Admission Test
Regulation.
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.
Copy 1 Admission Office
Receipt Form
PROSPECTIVE STUDENT
Form Number
Nomor Formulir
Full Name
Nama Lengkap
High School Name, City
Nama SMA, Kota
Phone Number
Nomor Telepon
ENTRY OPTION (Give tick ( ) in your option)
Mobile Number
Nomor HP
DOCUMENTS TO BE SUBMITTED (Filled by Staff)
Direct Admission
Admission Test
Scholarship - Direct Admission
Scholarship - Admission Test (for Medical School)
PREFERENCE MAJOR
Place | Tempat
Date | Tanggal
1st Major
2nd Major
3rd Major
Prospective Students Signature & Full Name

Tanda Tangan & Nama Lengkap Calon Mahasiswa
potong disini
Academic Year 2017/2018

UPH Global Campus
Copy 2 Prospective Student
Receipt Form
PROSPECTIVE STUDENT
Form Number
Nomor Formulir
Full Name
Nama Lengkap
High School Name, City
Nama SMA, Kota
Phone Number
Nomor Telepon
ENTRY OPTION (Give tick ( ) in your option)
Mobile Number
Nomor HP
DOCUMENTS TO BE SUBMITTED (Filled by Staff)
Direct Admission
Admission Test
Scholarship - Direct Admission
Scholarship - Admission Test (for Medical School)
PREFERENCE MAJOR
,
Place | Tempat
Date | Tanggal
1st Major
2nd Major
potong disini
3rd Major
Admission Staffs Signature & Full Name

Tanda Tangan & Nama Lengkap Staf Admisi
potong disini
Copy 1 Admission Office
Admission Statement
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 and based on the Pancasila and The Constitution of
Republic of Indonesia of 1945.
Mengetahui bahwa penyelenggaraan pendidikan di UPH/STPPH bercirikan iman Kristiani dan berdasarkan Pancasila dan Undang-undang Dasar 1945.
2. All documents that I submit are legal and binding. I am fully responsible for any consequences of 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.
3. I am willing to accept sanctions (Dismissal) from UPH/STPPH if I cannot submit a copy of a High School Certificate or Letter of Equivalency or PAKET C
certificate during re-registration or in special circumstances by the latest 1 (one) year after effective class begin, even though the tuition fee has been paid.
Saya bersedia menanggung sanksi (dikeluarkan) dari UPH/STPPH jika saya tidak dapat menyerahkan fotokopi ijazah SMA Nasional atau Surat Penyetaraan
Ijazah atau ijazah PAKET C selama pendaftaran ulang berlangsung atau dalam keadaan tertentu paling lambat 1 tahun setelah perkuliahan dimulai
walaupun sudah diterima dan membayar uang kuliah.
4. I truthfully declare that I have never been given any academic sanction or dismissal from any other university.
Saya menyatakan dengan sebenar-benarnya bahwa saya tidak pernah menerima sanksi akademik atau dikeluarkan dari universitas manapun.
5. As a foreign student, I am obliged to submit the foreign study permit issued by the Republic of Indonesia Ministry of Education and Culture and the
Indonesian Limited Stay Permit Card sponsored by UPH.
Sebagai warga negara asing, saya berkewajiban untuk menyerahkan surat ijin belajar warga negara asing yang dikeluarkan oleh Kementrian Pendidikan
dan Kebudayaan RI dan kartu ijin tinggal terbatas di Indonesia yang disponsori oleh UPH.
6. I understand that if I miss the first ten days of class without any notification, I will be considered to have withdrawn from UPH.
Saya mengerti jika saya tidak menghadiri 10 hari pertama perkuliahan tanpa keterangan apapun, maka saya dianggap mengundurkan diri dari UPH.
7. I understand that Double Degree and Dual Degree programmes will start after the first year of class. These programmes are subject to change according
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 specific program is full, UPH has the right not to accept any additional studetns in the class even though it is before the
payment deadline.
Saya mengerti bahwa jika batas maksimum kapasitas jumlah mahasiswa yang dapat diterima di jurusan tertentu sudah tercapai, maka UPH berhak
menolak menambah jumlah mahasiswa dikelas tersebut meskipun belum mencapai batas akhir pembayaran.
9. UPH is unable to return any documents that have been submitted as part of the application process.
UPH tidak dapat mengembalikan semua dokumen persyaratan pendaftaran yang telah dikumpulkan.
10. Once this document is signed, all payments that are transferred to the Pelita Harapan Foundation belong to the foundation and cannot be refunded for
any reason.
Setelah menandatangani dokumen ini, seluruh pembayaran yang telah ditransfer ke Yayasan Universitas Pelita Harapan menjadi milik yayasan dan tidak
dapat ditarik kembali dengan alasan dan kondisi apapun.
11. My parents and I hereby acknowledge and confirmed our acceptance of the consequences of provision number 10 as stated above and we will not file any
law suit in connection with provision number 10.
Saya bersama dengan orang tua saya dengan ini menegaskan bahwa kami sudah mengerti dan menerima konsekuensi dari ketentuan point 10 di atas dan
oleh karena itu kami tidak akan mengajukan gugatan hukum apapun di kemudian hari sehubungan dengan ketentuan nomor 10.
12. I agree to abide by the Regulations stated by the University, both now and in the future.
Saya bersedia mentaati Statuta, Peraturan Tata Tertib Kampus, dan peraturan lain yang telah dan akan diberlakukan.
13. I have read and fully understand the regulations and registration requirements stated in this Admission Manual
Saya telah membaca dan mengerti ketentuan serta persyaratan pendaftaran dalam Buku Petunjuk Admisi ini.
,
Place | Tempat
Date | Tanggal
potong disini
Please sign on the stamp duty/

Harap tanda tangan mengenai materai
PARENT/GUARDIANS SIGNATURE & FULL NAME

Tanda Tangan & Nama Lengkap Orang Tua/Wali
Stamp Duty/Materai
Rp. 6000

PROSPECTIVE STUDENTS SIGNATURE & FULL NAME

11
potong disini
Drug-Free Statement
I, the undersigned:
Form Number
Nomor Formulir
Full Name
Nama Lengkap
Place, Date of Birth
Tempat Tanggal Lahir
:
:
:
Hereby truly state that I : (Mark the corresponding statement)

Dengan ini menyatakan dengan sesunguhnya bahwa saya: (tandai pertanyaan yang sesuai)
Never take drugs nor am i involved with drugs in any forms.
Tidak pernah mengonsumsi narkoba dan terlibat narkoba dalam bentuk apapun.
Took drugs in the past but have been declaired free and clean from drugs, as proven by the official Drugs Exemption
Certificate from Siloam Hospital attached.
Pernah mengonsumsi narkoba namun sudah dinyatakan bebas dan bersih dari narkoba, dibuktikan dengan Surat
Keterangan Bebas Narkoba resmi dari Rumah Sakit Siloam terlampir.
Furthermore, I am willing to follow UPHs inspection procedures, including taking random urine and blood tests during my study at UPH.
Selanjutnya, saya bersedia mengikuti prosedur pemeriksaan yang dilakukan secara acak oleh pihak Universitas Pelita Harapan (UPH) termasuk tes
urine dan atau darah selama mengiktui proses belajar mengajar di UPH.
I hereby write this statement letter truthfully. I am willing to be processed under the rules in force at UPH, and willing to accept the Dismissal
Consequences should my statement prove to be untruthfully.
Demikian surat pernyataan ini saya buat dengan sesungguhnya. Saya bersedia diproses bedasarkan peraturan yang berlaku di UPH, serta bersedia
menerima segala konsekuensi termasuk dikeluarkan apabila di kemudian hari pernyataan saya terbukti tidak benar.
,
Place | Tempat
Date | Tanggal

Stamp Duty/Materai
Rp. 6000


potong disini
13
potong disini
Scholarship Application Form

Scholarship application for all categories
I, the undersigned:
Form Number
Nomor Formulir
Full Name
Nama Lengkap
Social Organization Or Leadership Activities / Aktivitas Sosial, Organisasi Atau Kepemimpinan

Student Council
Band/Orchestra
Scout
Red Cross Youth Council
Language Club
Flag-Raising Squad
Sport
Spiritual Activities
Others,
Choir/Vocal Group
Martial Arts
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 tick ( ) your option/silahkan beri tanda ( ) pada 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 menyatakan bahwa informasi diatas adalah benar.
,
Place | Tempat
Date | Tanggal
potong disini

Parent/Guardians Signature & Full Name

15
Art & Sport Scholarship Recommendation Form

Scholarship application for art achievement or sport achievement category
I, the undersigned:
Coach/Teacher Full Name
Nama lengkap Pelatih/Guru
High School/Institution Name

Nama Sekolah/Institusi
Art
Sport
Coach/Teacher of:
Pelatih/Guru
Coach
Pelatih
Guitar
Bass
Keyboard
Drum
Piano
Traditional Dance
Basketball
Swimming
Choir
Acting
Volleyball
Badminton
Vocal
Photography
Soccer
Futsal
Modern Dance
Video Editing
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. __________________________

Saya tegaskan informasi diatas adalah benar.
Coach/Teacher,
Pelatih/Guru
,
Place | Tempat
Date | Tanggal
Coach/Teachers Signature & Full Name + Stamp (if any)

Tanda Tangan & Nama Lengkap Pelatih/Guru + Cap (jika ada)
potong disini
16
School of Design Application Form
I, the undersigned:
Form Number
Nomor Formulir
Full Name
Nama Lengkap

Preferred Major | Jurusan Pilihan | Please give tick ( ) in your option | Silahkan berikan tanda ( ) dalam pilihan Anda
Architecture | Arsitek
Product Design | Desain Produk
Interior Design | Desain Interior
Visual Communication Design | Desain Komunikasi Visual
Additional Requirements
NO
1
2
DOCUMENT
Color Blindness Test Certificate by Ophthalmologist / Oculist
Sertifikat tidak buta warna dari Spesialis Mata
One Page Essay (A4; Line Spacing 1,5; Font Size: 12)
Satu lembar esai (A4; Spasi 1,5; Ukuran Huruf: 12)
Read this quote below:
Bacalah kutipan dibawah ini:
Design, to its essence, can be defined as the human capacity to shape and make our environment in ways with no direct example produce by nature, to
serve our needs and give meaning to our lives.
Desain, dalam esensinya, dapat didefinisikan sebagai kapasitas manusia untuk membentuk dan membuat lingkungan dengan cara yang tidak dapat
dihasilkan langsung oleh alam, untuk melayani kebutuhan kita dan memberikan makna bagi hidup kita.
Think carefully about it and write one page essay on what its your understanding about this quote and how this quote means to you as an inspiring designer/
architect. Explain critically.
Pikirkan dengan seksama dan tuliskan satu halaman esai mengenai apa yang Anda pahami dari kutipan ini dan bagaimana kutipan ini Anda maknai sebagai
seorang calon desainer atau arsitek. Jelaskan secara kritis.
Four (4) pieces hand drawing, A3 size drawing paper:
Empat lembar gambar tangan, dengan ukuran kertas A3:
Two (2) pieces drawing of object or scene in Product Design/Interior Design/Visual Communication Design/Architecture that demonstrates your essay above.
Write one paragraph to describe the object/scene you draw and why is it a good design result what you have written.
Dua lembar gambar objek atau adegan Desain Produk/Design Interior/Desain Komunikasi Visual/Arsitektur yang mendemonstrasikan tulisan Anda di atas.
Tuliskan satu paragraf dari objek/adegan yang Anda gambarkan dan alasan mengapa contoh tersebut merupakan hasil yang baik yang mencerminkan apa yang
sudah Anda tuliskan dalam esai.
Two (2) pieces drawing of people or human figure/partial human body interacting with an object (gadget, home, objects, furniture, automotive, etc), set within a
scene or place (room, outdoor scene, building, street, etc.). Use your preferred technique and tools (pencil, paint, and mix media).
Dua lembar gambar figur manusia/bagian tubuh manusia yang sedang berinteraksi dengan sebuah objek (gadget, perlengkapan rumah, furnitur, otomotif, dsb.),
yang di tempatkan dalam sebuah adegan atau tempat (ruangan, diluar ruangan, bangunan, jalan raya, dsb.). Gunakan teknik dan alat yang Anda kuasai (pensil,
cat, media campuran).
,
Place | Tempat
Date | Tanggal
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Conservatory of Music Application Form

NOTES
1. Check the admission requirement and procedure at http://music.uph.edu/admission/com-procedure.html
2. Applicants for all concentrations have to submit a good quality DVD/VCD recording which refer to website.
3. Applicants may be asked to take a Music Placement Test (Music Theory and Solfeggio).
4. The Recommendation form (p.20) must be completed by the referee.
Form Number
Nomor Formulir
Full Name
Nama Lengkap
High School Name

Nama Sekolah
NO
1
ADDITIONAL REQUIREMENTS FOR CONSERVATORY OF MUSIC

For procedure and audition requirements (include sample of Theory and Solfeggio Exam), please see http://music.uph.edu/admission/com-procedure.html
CLASSICAL INSTRUMENT
NON-CLASSICAL INSTRUMENT
Piano
Viola
Harp
Trumpet
Oboe
Piano
Contra-Bass
Trumpet
Vocal
Cello
Clarinet
Trombone
Saxophone
Vocal
Drum
Trombone
Guitar
Contra-Bass
Bassson
Tuba
Electric Guitar
Percussion
Flute
Violin
Percussion
French Horn
Flute
Electric Bass
Saxophone
PREFERED CONSENTRATION ON YOUR PASSION (CHOOSE ONE)/KONSENTRASI PILIHAN BERDASARKAN MINAT ANDA (PILIH SALAH SATU)
Church Music
Composition
Music Education
Performing Arts Production & Management
Classical Performance
Jazz & Pop Music Performance
Music Theraphy
Sound Design & Music Production
Note:
Prefered concentration will be started on 2nd Academic Year.
Konsentrasi Pilihan akan dimulai pada tahun kedua.
Why did you choose UPH Conservatory of Music? Describe.
Mengapa Anda memilih Conservatory of Music UPH? Jelaskan.
Who is your favorite composer or performer? Why?

Siapa komposer/performer favorit Anda? Mengapa?
Why did you choose your choice consentration?

Mengapa Anda memilih pilihan konsentrasi tersebut?
Ensemble playing experience: Yes/No

Apakah Anda pernah memainkan ensemble: Ya/Tidak
Mention the repertoire that you have learned!

Sebutkan repertoar yang pernah Anda pelajari!
Did you apply to a Conservatory of Music other than UPH? Yes/No

Apakah Anda mendaftar ke jurusan Musik selain di UPH? Ya/Tidak
How does music impact your life?

Bagaimana musik memberi dampak bagi hidup Anda?
Recent teacher name: _______________________________

Nama guru saat ini
Institution/music schools: ___________________________
Institusi/sekolah music
Music award ever received (if any): ____________________
Penghargaan musik yang pernah diterima (jika ada)
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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19
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 students 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. Doesnt 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. Havent 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
,
Place | Tempat
Date | Tanggal
20
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Referees Signature & Full Name + Stamp (if any)

Tanda Tangan & Nama Lengkap Pemberi Rekomendasi + Cap (jika ada)
Faculty of Medicine Application Form

Form Number
Nomor Formulir
Full Name
Nama Lengkap
Place & Date of Birth

:
Tempat & Tanggal Lahir
Name of Parent
Nama Orang Tua
Name of Family Doctor

Nama Dokter Keluarga
NO
ADDITIONAL REQUIREMENTS FOR FACULTY OF MEDICINE
Color Blindness Test Certificate by Ophthalmologist / Oculist
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.
2 Recent Photo size 3x4 using white collared shirt with blue background
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.
By signing this form, I agree to abide by the regulation stated by Faculty of Medicine, both now and in the future. This include all activities and examination that
may be held outside of Monday to Friday.
Dengan menandatangani form ini, saya bersedia menaati peraturan yang telah diberlakukan dan akan diberlakukan oleh Fakultas Kedokteran. Hal ini
mencakup semua kegiatan dan ujian yang mungkin diadakan diluar hari Senin hingga Jumat.
Prospective Student,
Calon Mahasiswa
,
Place | Tempat
Date | Tanggal
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21
Health Declaration Form

I, the undersigned:
You will be required to complete the Health Declaration Form prior to join 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.
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.
Full Name
:
Nama Lengkap
NO
YES/
YA
HEALTH DECLARATION/PERNYATAAN
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?
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?
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?
Have you ever suffered from tuberculosis (TB) within the past 12 months?
Apakah Anda pernah menderita tuberkulosis (TB) dalam 12 bulan terakhir?
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?
Have you had a cough for more than 3 weeks?

Apakah Anda menderita batuk lebih dari 3 minggu?
Have you coughed up blood?

Apakah Anda pernah batuk berdarah?
Have you had any unexplained weight loss?

Apakah Anda pernah kehilangan berat badan tanpa sebab yang dapat dijelaskan?
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 2017 di hari kerja.

NO/
TIDAK
DETAILS/
KETERANGAN
Medical School New Student,

Mahasiswa Baru Fakultas Kedokteran
22
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Faculty of Psychology Application Form

I, the undersigned:
Form Number
Nomor Formulir
Full Name
Nama Lengkap
Phone/Mobile Number
Nomor Telepon
e-mail address
Alamat e-mail

Preferred Concentration | Konsentrasi Pilihan | Please give tick ( ) in your option | Silahkan berikan tanda ( ) dalam pilihan Anda
Psychology | Psikologi
Psychology & Entreprenurship | Psikologi & Kewirausahaan
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).
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).
,
Place | Tempat
Date | Tanggal

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24
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 30, 2017)
* we accept only TOEFL/IELTS results from LIA, AMINEF, TOEFL/IELTS International
REQUIREMENTS / PERSYARATAN
1. This form is required ONLY for Prospective Student who apply to the available Full English Class as listed below:
- Communication
- International Relation
- Law
- Food Technology
- Hospitality Management
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.
Notes:
- UPH Business School also offers Joint Degree and International Class Program.
- Upon registration, student who applied to Business School International Program (Joint Degree & International Class) and Foreign Student
(Non Indonesian Citizen) required to submit TOEFL IBT or IELTS Certificate with minimum score 71 for TOEFL IBT or 5.5 for IELTS.
____________, __________________
Place
Date
Received by,
Verified by
( ___________________________________ )
( ___________________________________ )
Admission Staffs Signature & Full Name
( ___________________________________ )
UPH Language Centers Signature & Full Name
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Form 020
Re-Registration Procedure | Prosedur Daftar Ulang

Complete and submit all the requirements below to the Academic Administration Directorate of UPH/STPPH at Bldg. A 3rd fl. ,
on July 1- August 31, 2017 during weekdays at 07.30 AM until 4 PM
Lengkapi dan serahkan persyaratan di bawah ini ke Direktorat Administrasi Akademik UPH/STPPH di Gedung A lt.3
pada 1 Juli-31 Agustus 2017 selama hari kerja pukul 07.30 - 16.00 WIB
GENERAL REQUIREMENTS / PERSYARATAN UMUM

CHECK
TO BE SUBMITTED / HARUS DILENGKAPI
JUMLAH
A copy of Birth Certificate

Fotokopi Akte Kelahiran
1 Piece
1 Lembar
A copy of valid ID/Driving License/Passport

Fotokopi KTP/SIM/Paspor yang masih berlaku
1 Piece
1 Lembar
A recent photos 4x6 using collared shirt with a blue background.

Write name and major on the back of the photo.
Pasfoto ukuran 4x6 menggunakan kemeja berkerah dengan berlatar belakang biru.
Tuliskan nama dan Jurusan Mahasiswa di bagian belakang foto.
2 Piece
2 Lembar
Receipt of payment legalized by UPH Finance Department

Bukti pelunasan pembayaran SPP/ BPP/SKS yang telah divalidasi oleh Biro Keuangan UPH
1 Piece
1 Lembar
A complete FORM 021 that has been signed by Prospective Student and Parent/Guardian.
FORM 021 yang telah diisi lengkap dan ditandatangani oleh Mahasiswa dan Orangtua/Wali
1 Piece
1 Lembar
Additional Requirements for Indonesian Student

Syarat Tambahan bagi Calon Mahasiswa Warga Negara Indonesia
CHECK
National & International Curriculum in Indonesia
JUMLAH
A Copy Of High School Final Certificate Legalized by Principal

Fotokopi Ijazah SMA dilegalisasi oleh Kepala Sekolah
1 Piece
1 Lembar
A Copy of National Examination Certificate (SHUN)/Transcript Legalized by Principal

Fotokopi Sertifikat Hasil Ujian Nasional (SHUN)/Transkrip Nilai dilegalisasi oleh Kepala Sekolah
1 Piece
1 Lembar
Non-Formal Education (PKBM) and Informal Education (Homeschooling)

A Copy of Legalized PAKET C Certificate
Fotokopi Ijazah PAKET C dilegalisasi
1 Piece
1 Lembar
Overseas School
A Highschool/Diplomas Equivalent Statement issued by Ministry of Education & Culture RI
Surat Penyetaraan Ijazah/Diploma dari Kementerian Pendidikan dan Kebudayaan Republik Indonesia
1 Piece
1 Lembar
Additional Requirements for Foreign Student (Non Indonesian Citizen)

Syarat Tambahan bagi Calon Mahasiswa Warga Negara Asing
CHECK
TO BE SUBMITTED / HARUS DILENGKAPI
JUMLAH
Foreigner Study Permit issued by Ministry of Education and Culture RI

Surat Izin Belajar Warga Negara Asing yang dikeluarkan oleh Kementerian Pendidikan dan Kebudayaan RI
1 Piece
1 Lembar
The Indonesian Limited Stay Permit Card

Kartu Izin Tinggal Terbatas (KITAS) di Indonesia
1 Piece
1 Lembar
Checked By,
Diperiksa Oleh,
Date | Tanggal :
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Biro ADAK
27
Form 020
Form Number
Nomor Formulir
Fill in with Capital Letter

Isi dengan huruf cetak
:
Major
Jurusan
Details | Keterangan
NO
Students Data | Data Mahasiswa/i
Full Name *) | Nama Lengkap *)
Date/Place of Birth *) | Tempat/Tanggal Lahir *)
Sex | Jenis Kelamin
( ___ ) Male | Laki - laki
( ___ ) Female | Perempuan
Civilian Status | Status Sipil
( ___ ) Married | Menikah
( ___ ) Unmarried | Belum Menikah
Religion | Agama
Nationality | Kewarganegaraan
Full Address (Include Residence & Zip Code) |

Alamat Lengkap (Perumahan, RT/RW & Kode Pos)
High School (Name & Address)

Asal Sekolah (Nama & Alamat)
Phone & Mobile Phone | No. Telp dan HP
10
e-mail Address | Alamat e-mail
11
ID Card or Driving License Number |

No. KTP / No. SIM
DD-MM-YY
NO
1
Religion | Agama

E-mail Address | Alamat Email

(Penting untuk Laporan Nilai Ujian per Semester)
Recent Education | Pendidikan Terakhir
Occupation | Pekerjaan
10
Fathers Data | Data Ayah
NO
1
Religion | Agama

E-mail Address | Alamat Email

(Penting untuk Laporan Nilai Ujian per Semester)
Recent Education | Pendidikan Terakhir
10
Place | Tempat
Mothers Data | Data Ibu
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I affirm the above

information is true.
Saya tegaskan informasi
di atas adalah benar.
28
Date | Tanggal
PARENT/GUARDIANS FULL NAME & SIGNATURE


Copy 2 Prospective Student
Admission Statement
I, the undersigned:
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 and based on the Pancasila and The Constitution of
Republic of Indonesia of 1945.
Mengetahui bahwa penyelenggaraan pendidikan di UPH/STPPH bercirikan iman Kristiani dan berdasarkan Pancasila dan Undang-undang Dasar 1945.
2. All documents that I submit are legal and binding. I am fully responsible for any consequences of 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.
3. I am willing to accept sanctions (Dismissal) from UPH/STPPH if I cannot submit a copy of a High School Certificate or Letter of Equivalency or PAKET C
certificate during re-registration or in special circumstances by the latest 1 (one) year after effective class begin, even though the tuition fee has been paid.
Saya bersedia menanggung sanksi (dikeluarkan) dari UPH/STPPH jika saya tidak dapat menyerahkan fotokopi ijazah SMA Nasional atau Surat Penyetaraan
Ijazah atau ijazah PAKET C selama pendaftaran ulang berlangsung atau dalam keadaan tertentu paling lambat 1 tahun setelah perkuliahan dimulai
walaupun sudah diterima dan membayar uang kuliah.
4. I truthfully declare that I have never been given any academic sanction or dismissal from any other university.
Saya menyatakan dengan sebenar-benarnya bahwa saya tidak pernah menerima sanksi akademik atau dikeluarkan dari universitas manapun.
5. As a foreign student, I am obliged to submit the foreign study permit issued by the Republic of Indonesia Ministry of Education and Culture and the
Indonesian Limited Stay Permit Card sponsored by UPH.
Sebagai warga negara asing, saya berkewajiban untuk menyerahkan surat ijin belajar warga negara asing yang dikeluarkan oleh Kementrian Pendidikan
dan Kebudayaan RI dan kartu ijin tinggal terbatas di Indonesia yang disponsori oleh UPH.
6. I understand that if I miss the first ten days of class without any notification, I will be considered to have withdrawn from UPH.
Saya mengerti jika saya tidak menghadiri 10 hari pertama perkuliahan tanpa keterangan apapun, maka saya dianggap mengundurkan diri dari UPH.
7. I understand that Double Degree and Dual Degree programmes will start after the first year of class. These programmes are subject to change according
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 specific program is full, UPH has the right not to accept any additional studetns in the class even though it is before the
payment deadline.
Saya mengerti bahwa jika batas maksimum kapasitas jumlah mahasiswa yang dapat diterima di jurusan tertentu sudah tercapai, maka UPH berhak
menolak menambah jumlah mahasiswa dikelas tersebut meskipun belum mencapai batas akhir pembayaran.
9. UPH is unable to return any documents that have been submitted as part of the application process.
UPH tidak dapat mengembalikan semua dokumen persyaratan pendaftaran yang telah dikumpulkan.
10. Once this document is signed, all payments that are transferred to the Pelita Harapan Foundation belong to the foundation and cannot be refunded for
any reason.
Setelah menandatangani dokumen ini, seluruh pembayaran yang telah ditransfer ke Yayasan Universitas Pelita Harapan menjadi milik yayasan dan tidak
dapat ditarik kembali dengan alasan dan kondisi apapun.
11. My parents and I hereby acknowledge and confirmed our acceptance of the consequences of provision number 10 as stated above and we will not file any
law suit in connection with provision number 10.
Saya bersama dengan orang tua saya dengan ini menegaskan bahwa kami sudah mengerti dan menerima konsekuensi dari ketentuan point 10 di atas dan
oleh karena itu kami tidak akan mengajukan gugatan hukum apapun di kemudian hari sehubungan dengan ketentuan nomor 10.
12. I agree to abide by the Regulations stated by the University, both now and in the future.
Saya bersedia mentaati Statuta, Peraturan Tata Tertib Kampus, dan peraturan lain yang telah dan akan diberlakukan.
13. I have read and fully understand the regulations and registration requirements stated in this Admission Manual
Saya telah membaca dan mengerti ketentuan serta persyaratan pendaftaran dalam Buku Petunjuk Admisi ini.
N
E
M
I
C
E
P
,
Place | Tempat
Date | Tanggal
potong disini


Stamp Duty/Materai
Rp. 6000


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MESSAGE

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

Welcome to UPH Global Campus,

Selamat datang di UPH Global Campus,

This Admission Manual has been prepared to

Buku Petunjuk Pendaftaran ini dipersiapkan untuk memberikan

provide you with comprehensive information regarding

informasi menyeluruh mengenai Program Sarjana Strata 1 dan

UPH Undergraduate Programs and enrollment procedures.

prosedur penerimaan mahasiswa baru.

We welcome you to the UPH family and would like to introduce

Kami menyambut Anda sebagai bagian dari Keluarga UPH dan

you to the vision of our university: True Knowledge, Faith in

memperkenalkan Anda tentang visi UPH, yaitu: Pengetahuan

Christ, and Godly Character.

Sejati, Iman Dalam Kristus, dan Karakter Ilahi.

UPH is committed to serving you in the best possible ways, by

UPH berkomitmen memberi Anda pelayanan terbaik dengan

providing holistic and internationally recognized education, world-

menyediakan pendidikan holistis berkualitas internasional, didukung

class facilities, technology, and infrastructure. UPH also prepares

fasilitas, teknologi serta infrastruktur kelas dunia.

students to be globally informed and appreciated by multi-national

UPH juga mempersiapkan mahasiswa agar dapat diakui secara global

industries and businesses.

dan diapresisasi oleh industri dan bisnis modern.

We welcome you to the UPH Global Campus in Indonesia

Selamat datang di UPH Global Campus, dimana kami

where learning is dinamic within an excellent holistic

menyediakan proses pembelajaran yang dinamis melalui

lingkungan pendidikan holistis yang terbaik di Indonesia.

Saya berdoa kiranya Tuhan selalu memberkati Anda selama masa

Message from The Rector

Admission & Scholarship Schedule

Additional Requirements for Scholarship

Admission Test Regulations

Drug Free Statement

Scholarship Application Form

Art & Sport Scholarship Recommendation Form

School of Design Application Form

Conservatory of Music Application Form

Conservatory of Music Recommendation Form

Faculty of Medicine Application Form

Health Declaration Form

Faculty of Psychology Application Form

School of Phylosophy and Divinity Application Form

Full-English Class Application Form

New Student Re-Registration Form

New Student Data Form

Admission Statement (Prospective Student)

(Failed Scholarship, Accepted Reguler)

Submit Re-Registration Form

Join UPH Festival as a New student

Completed form will be processed within 14 working days.

Admission result will be announced by 2 (two) methods:

1ST METHOD | METODE 1

Offering Letter dikirimkan ke alamat email calon mahasiswa

2ND METHOD | METODE 2

Offering Letter ditampilkan di website pendaftaran online

NOMOR FORMULIR DIBUTUHKAN UNTUK MELAKUKAN PEMBAYARAN. NOMOR

If you need more detailed information, please contact us through:

Admission Scholarship and Schedule

SCHOLARSHIP SCHEDULE 2017/2018

22 AUG - 02 SEPT 2016