APPLICATION FORM Academic Year 2023/2024

Undergraduate Students Universitas Pelita Harapan

New Student Re-Registration Form

Form 020
Re-Registration Procedure | Prosedur Daftar Ulang
Complete and submit all the requirements below
no later than 60 days since announcement email received.
Lengkapi dan serahkan persyaratan di bawah ini
selambat-lambatnya 60 hari sejak email pemberitahuan diterima.

GENERAL REQUIREMENTS / PERSYARATAN UMUM

CHECK TO BE SUBMITTED / HARUS DISERAHKAN JUMLAH

A scanned of Birth Certificate. 1 Piece
Hasil Scan Akte Kelahiran. 1 Lembar
A scanned of valid KTP for WNI (Colour), Passport for Foreign Student/WNA (Colour). 1 Piece
Hasil Scan KTP bagi WNI (Berwarna), Paspor bagi Mahasiswa Luar Negeri/WNA (Berwarna). 1 Lembar
A recent photo file in collared shirt with a blue background. 1 Pieces
FIle Pasfoto menggunakan kemeja berkerah dengan latar belakang berwarna biru. 1 Lembar
A scanned of completed FORM 021 that has been signed by Prospective Student and Parent/Guardian. 1 Piece
Hasil scan FORM 021 yang telah diisi lengkap dan ditandatangani oleh Mahasiswa dan Orangtua/Wali. 1 Lembar

A scanned of Rules and Regulations regarding the Student Code of Ethics (Only last page). 1 Piece
Hasil scan Tata Tertib dan Peraturan Tentang Kode Etik Mahasiswa (Hanya halaman terakhir). 1 Lembar

A scanned of Admission Statement (Only second page). 1 Piece

Hasil scan Surat Pernyataan Admisi (Hanya halaman kedua). 1 Lembar

Additional Requirements for Indonesian Students

Syarat Tambahan bagi Calon Mahasiswa Warga Negara Indonesia
CHECK National & International Curriculum in Indonesia JUMLAH
A scanned of original of High School Final Certificate. 1 Piece
Hasil Scan Ijazah SMA asli. 1 Lembar

Non-Formal Education (PKBM) and Informal Education (Homeschooling)

A scanned of original of PAKET C Certificate. 1 Piece
Hasil scan Ijazah PAKET C Asli. 1 Lembar

Overseas School
A scanned of certified High School/Diploma’s Equivalent Statement issued by Ministry of Education, Culture, Research
and Technology Republic of Indonesia. 1 Piece
Hasil scan Surat Penyetaraan Ijazah/Diploma dari Kementerian Pendidikan, Kebudayaan, Riset dan Teknologi 1 Lembar
Republik Indonesia.

Additional Requirements for Foreign Students (Non Indonesian Citizen)

Syarat Tambahan bagi Calon Mahasiswa Warga Negara Asing
CHECK TO BE SUBMITTED / HARUS DILENGKAPI JUMLAH
A scanned of Foreigner Study Permit issued by Ministry of Education, Culture, Research and Technology Republic of
Indonesia. 1 Piece
Hasil scan Surat Ijin Belajar Warga Negara Asing yang dikeluarkan oleh Kementerian Pendidikan, Kebudayaan, Riset 1 Lembar
dan Teknologi Republik Indonesia.
A scanned of valid Indonesian Limited Stay Permit Card. 1 Piece
04

Hasil scan Kartu Izin Tinggal Terbatas (KITAS) di Indonesia yang masih berlaku. 1 Lembar
SECTION

SEND TO: Checked By,

UPH Mobile Application (Re-Registration Menu). Diperiksa Oleh,
Download at Playstore or Appstore.
Aplikasi UPH Mobile (Menu Re-Registration)
Unduh melalui Playstore atau Appstore. Date | Tanggal :

If there are problems with the UPH Mobile application

please contact ITD Team at application.services@uph.edu
Jika ada kendala dengan aplikasi UPH Mobile harap hubungi
tim ITD di application.servicES@UPH.EDU
Registrar UPH

32