Student Exchange

Registration Form for Student Exchange Program

Personal Details

Name*

Last Name

Gender

Date of Birth*

Street Address*

City*

Province

Post code

Phone Number*

Email Address*

Current Studies

NIM*

GPA*

Study Program

Degree Program*

TOEFL/IELTS Score*

Choice of exchange

List your preferences below, what kind of activity do you want to do and which university do you want to come:

The Activity

The University

attachment

TOEFL/IELTS Certificate

Transcript

Study Plan

SELF CHECK UP HEALTH NFORMATION FORM

Certificate of Health Form

Motivation Letter

Scan Passport

Emergency Contact

Nama Emergency Contact*

Phone Number Emergency Contact*

Student Exchange Form