Exchange, Internship and Short Course Immigration Form

Documents Template:
bit.ly/docstemplateIRO

Immigration Guidance Book:
bit.ly/ImmigrationGuidanceIRO

Short Course, Student Exchange and Internship Immigration Form

All scanned documents must be in colour, clearly readable, not cut off and all scanned documents maximum file size 300 kb (jpg or pdf)

Name (Full Name)(Required)

Place of Birth(Required)

Date of Birth(Required)

Sex(Required)

Male

Female

Nationality(Required)

Passport Number(Required)

Issued(Required)

Expired(Required)

Marital Status(Required)

Spouse Name (for Married)

Phone/Mobile Number(Required)

Your Whatsapp Number, If you have Indonesian number please fill it

Social Media(Required)

Instagram/Facebook

Active Email(Required)

Faculty(Required)

Faculty in UMY

Department(Required)

Department in UMY

Origin Address(Required)

Input Village Name, Street Name, and House Number

City(Required)

Province/State(Required)

Country(Required)

Postal Code(Required)

Have You Ever Been to Indonesia?(Required)

Yes

Funding Source(Required)

UMY Scholarship

Self-Funded

Your University/Other Institutions

Please submit this required documents below

Recent Formal Photo(Required)

Accepted file types: jpg, png, pdf, Max. file size: 1 MB.

Size 4x6, formal attire, red background

Scanned Passport Bio(Required)