Visiting Fellow Form for UMY’s Staff

This Form is for a UMY Staff who wants to apply for Visiting Fellow Program with Universitas Muhammadiyah Yogyakarta.

Name*
First Last
Faculty*
Department*
Position*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Passport Number*
Date of Issue*
MM slash DD slash YYYY
Expired Date of Issue*
MM slash DD slash YYYY
Issued Country*
Phone*
Emergency Contact*
Email*
Partners for Collaboration
Partner's Profile
Name University Faculty Department/ Program Country E-mail
Proposed Program
Kind Of The Programe
Duration Of The Programe
Please Upload These Following Documents
Application Form*
Max. file size: 2 MB.
Please collect your group's application form in one combined file.
Proposal*
Max. file size: 2 MB.
Please use this formatting name: NAME_PROP_VF (e.g. BUDI_PROP_VF)
Mobility Agreement*
Max. file size: 2 MB.
Please use this formatting name: NAME_MOA_VF (e.g. BUDI_MOA_VF)
Surat Pengajuan Visiting Fellow*
Max. file size: 2 MB.
Please use this formatting name: NAME_Pengajuan_VF (e.g. BUDI_Pengajuan_VF)
Surat Pernyataan Komitmen dan Tanggung Jawab*
Max. file size: 2 MB.
Please use this formatting name: NAME_Komitmen_VF (e.g. BUDI_Komitmen_VF)
Application Scanned Passport (Bio-Date Page Only)*
Max. file size: 2 MB.
Please collect your group's scanned passport in one combined file.

Name	University	Faculty	Department/ Program	Country	E-mail

Full Time Enrollment