Capplication Form 1/4] National Yunlin University of Science and Technology Application Form for Admission of International Students HU SAARABS TO THE APPLICANT : © SHA APARANS SRR AMY This application form should be completed with two copies. © JB P ALE IEA Please complete this form in Chinese or English and print in BLOCK LETTERS. 1. {8A 3249 Personal Information AStA Spa iF | | BAS | (PX Chinese) (RX English) Applicant's | - ABEL AGUSTA BANUBORO Name Hee a = aw Date of Birth | 20° AUGUST 1996 Gender 4 SB Male a & Female Bl i 5 pai aS Nationality | INDONESIA Birth Place | JEPARA Passport No. | ©2856579 & it MULYOHARIO VILLAGE RT 01/RW 03, JEPARA SUB-DISTRICT, JEPARA DISTRICT, Home Address|_CENTRAL JAVA, INDONESIA (59413) Address, tie MULYOHARIO VILLAGE RT 01/RW 03, JEPARA SUB-DISTRICT, JEPARA DISTRICT, 8 | CENTRAL JAVA, INDONESIA (59413) BFR | Ablagsi@email.com E-mail |Contact Person] a THR a Telephone _|~ Cell Phone] *6? 823-298-2609 sein | BAGMaried [208 singte | 7%, Marital status | o 2th Other tien. |_ PRES RMES i Chinese | - English | EKO KASIONO ee Name Name BEaw Te Father /""Date of | 15 APRIL 1963 ie ity | INDONESIA ae tionality PRES RNeS ie Chinese | - English | WAKHIDATUL KHASANAH olan bye Name i HEAR Mother |""Date of | 22 MARCH 1968 Dee onatiy | INDONESIA a ationality PER REA 4EGBHBA | Chinese | - English | - Contact Person|_Name Name in Taiwan | a |. eae | _ Telephone E-mail eame fest Address of | ~ in TaiwanLApplication Form 2/4) T0855 R Educational Background HE LEE aR PSB 3 BRRSIXT | Graduate schoot | Graduate schoat Degree | Secondary school |College or University] taster Program) | (Ph.D. Program) SENIOR HIGH | UNIVERSITAS ‘RRB | SCHOOL | NEGERI Name of school | JEPARA SEMARANG (SMAN | JEPARA)| (UNNES) spughiteth | JEPARA, SEMARANG, Location _| INDONESIA INDONESIA Bil a SARJANA TEKNIK | Degree granted (S.T)/ (BEng) GRAB | oa 2018 Graduation year Ets CIVIL Magee _|OENE ENGINEERING BNE | sctence STRUCTURE Minor TL, RP MRAZA RAL For which degree do you wish to apply ? - [aR te El SRAM 1 Choice _: CONSTRUCTION ENGINEERING Department! gy at = Graduate School x8 Choice _: CONSTRUCTION AND PROPERTY ENGINEERING O B+ (De) Ot (lal /2+2 BEBE) |Bachclor’s (four-years) Bachelor's (two-years / 2+2 Bilateral Agreement) matt ORLeeae Degree [4] Wit Master's [+1 Master’s (+1 Bilateral Agreement) CHW t Doctorate TV. ADS : ERROR RAR Financial Support: What will be your major source of financial support during study? 2 (BAGEE Personal Savings #284 Amount, Go 34H Parental Support Ff Amount, | SMH Taiwan Scholarship co S260 Scholarship ARIK Source, #@35, Amount, co Atti Other Resources V. BREWS Tuition Waiver () BLSREPMARMARZHPASEPSA SLSR BRIG ? ‘Would you apply the Tuition Waiver? Mi BE Yes O*A®8E Noapplication Form 3/4] 2) MERAMARERARER CRA MARAMAR ? Do you still enroll YunTech even without the tuition waiver? ORE Yes WARE No VI, 8428 Dormitory SRUCGLAS FOREST - ORRAAG AATMOMMAES, ASKSSIOR CBR R + ZARRPAARBLBS ? We offer dormitory for international students but no bedding will be provided. Students who apply for dormitory will have to prepare bedding stuff by themselves. Also, smokeing, cooking and drinking alcohol beverage are prohibited in the dormitory. Would you like to apply for the dormitory? Y 2h REARS - WHAMUMANLPERSAMLHRETRSRE Yes, I would like to live in dormitory, agree to fill in the contract of living in dormitory and comply with all regulations. OF RARERAES No, please do not reserve dormitory for me. VIL. AX AEF) Languages Proficiency ©English Language OEE SO SGS SL 5 73 UR? Have you taken any English proficiency test? aaa MW Byes Tfyes, what is the TOEFL ITP name of the test? Score E3287 (4 Please evaluate your English skills. EE Listening a B Excellent [| Good Bal Average i Speaking 18 Excellent 0 3) Average Reading ofS Excellent Good co A] Average S Writing 0 & Excellent Good MOT Avera OChinese Language 8p EE? How many years have you formally studied Chinese?| NEVER ARPA P - AB - sa HM)? Where did you study Chinese (high school, college, | - language institute)? Ebr = eae a Yes I yes, what is the IH, aveyeu laken-any name of the test? Chinese proficiency test?| 1 @ No BB 51 #287 {4 Please evaluate your Chinese skills. ¥5 Listening © {@ Excellent © f€ Good o MSO] Average oo @Excellen | 0 fF Good 5 MO) Average a @ Excellent a t Good 3 8) Average Writing co Excellent a ££ Good 5 (46) Average 3 Please submitted the copies of all the related certificates along with this form. 3Lapplication Form 4/4] VII. Others + {0 EAELARFAR RAL « Please specity physical illness or disability if have. * MOS REPRE « DARUOAERZUGEIR » SEE / PEAR EAR ~ HUN - CAN ESERS Please list your publications, including the published year, titles of publications, publishers, published locations, if have. * #G9E Honored Activities and Working Experiences, Month/Year | Full/Part Time ‘Name of Organization PositionHeld | Ase 2/88 Aaa att 2014-2015, PART TIME CIVIL ENGINEERING RESEARCH | MEMBER CLUB (CeRO) 2015-2016 PART TIME CIVIL ENGINEERING RESEARCH | VICE CHAIRMAN CLUB (CeRC) 2015-2016 PART TIME PROJECT SEASIDE VILLA SITE ENGINEER 2017 PART TIME STUDENT EXCHANGE PERMATA | - PROGRAM 2018-2019) PARTTIME | PROJECT PLAJAN VILLAGE, SITE ENGINEER