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CE-02

CREDIT EARNING FORM

Student Number : 2106719776


Family Name : Budiono
Given Name : Natasya
Place & Date of Birth : Palembang, May 4th 2003
Home Address : Jl. Tanjung Duren Barat III No. 26B………………...Postal Code : 11470
Home Phone No. : (021) 5640815
Mobile Phone No. : 08119191715…Email : natasya.budiono@sma.santaursulajakarta.sch.id.
Father’s Name : Stephen Budiono
Mobile Phone No. : 081317433180…Email : sumarni_stephen@yahoo.com
Mother’s Name : Sumarni
Mobile Phone No. : 0816-1920-645…Email : physical.rehab.clinic@gmail.com

For the purpose of credit earning process, my options are


1. University : Yale University (accepted)
Scheme : Study abroad X Student Exchange

2. University : Nanyang Technological University


Scheme : Study abroad X Student Exchange

The options above are my priority (in rank) to continue my study.

Depok, May 2nd 2003

Student, Academic Advisor,

Natasya Budiono Asiah Muchtar, S.E., M.A.


Notes from Academic Advisor:
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