FULL TIME-STUDY SCHOLARSHIP STUDENTS IMMIGRATION PROCEDURE FORM

Personal Data & Required Files

ATTENTION!

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)

Religion(Required)

Phone/Mobile Number(Required)

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

Social Media(Required)

Instagram/Facebook

Active Email(Required)

Father's Name(Required)

Mother's Name(Required)

Faculty(Required)

Faculty in UMY

Department(Required)

Department in UMY

Years Intake(Required)

Latest Education(Required)

Elementary School, Junior Highschool, Senior Highschool, University

Graduation Year(Required)

Origin Address(Required)

Input your Village Name, Street Name, House Number

City(Required)

Province/State(Required)

Country(Required)

Postal Code(Required)

Have You Ever Been to Indonesia?(Required)

Yes

Are you previously studied in other University in Indonesia?(Required)

Yes

Addressed to candidate of Master and Doctoral Degree Students

Funding(Required)

Self Funded

UMY Scholarship

MEDAT/SBPAC

Required Documents

Please submit this required documents below

Recent Formal Photo(Required)

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

Wearing formal attire, red background

Scanned Passport Bio(Required)