25 January 2024

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Your application details:

Application for: Dwi Atmoko Agung Nugroho

Generated on: 25 January 2024 2:14am

Applicant type
Select your citizenship type, then select application type

Citizenship Type:
HUMANITARN

Application Type:
Full Degree

Course selection
Select your course.

Course Selection
Select your course, course location, entry point and major (if required).

Course: Bachelor of Music (Honours) (BH009)

Location: Perth (Crawley campus)
Entry point: Semester 2, 2024

Course details
Please provide the following information

Course details - Additional questions

Based on your course selection, we require additional information to help us assess your application.

Honours
Please enter the name(s) of your proposed honours supervisor(s) if you have one. I do not know yet who my supervisor will be.
Are you planning on undertaking joint honours? Yes, I am planning on taking joint honours and my second discipline area will be:
Animal Behavior
Please provide a brief description of your proposed honours project. My research topic is proposed to be: Making Guitar ensemble duet
with another instruments under theme of animal behavior such as: swimming fish in the big aquarium
Please provide the title of your proposed honours project. Enter n/a if you have not yet decided on a title. n/a
If you know what the unit codes and names of the honours units you will enrol in are, please enter them below. Enter n/a if you don't
know them at this stage. n/a

The University of Western Australia M353, Perth T +61 8 6488 2477 E admissions@uwa.edu.au
WA 6009 Australia www.study.uwa.edu.au CRICOS: 00126G
PRV12169, AUSTRALIAN UNIVERSITY
 25 January 2024
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Admission pathway
If you do not meet the admission requirements for the course you are applying for, would you like UWA to offer you a pathway to your
chosen course? This may include UWA providing your personal details to a third party, UWA's pathway provider, UWA College. Yes
Advanced Standing (Credit)
You may be eligible for advanced standing (credits) if you have completed units similar to those in the course for which you are
applying. Do you wish to be considered for advanced standing? Yes

Qualifications
Tell us about your education history.

Post-secondary education
Enter the details of any post-secondary (TAFE, technical college, undergraduate or postgraduate) study you have undertaken and upload
copies of your academic transcripts.

Where did you complete post-secondary education: Other Institution

Country: Indonesia
Institution: Gadjah Mada University
Course Level and Duration: Magister (S2)
Award level: Successfully completed course and obtained award
Year: 2011
Course: Magister Psikologi
Grading System Cumulative GPA out of 4.0
Final Score 3.57
Documents:
Psyhology School certification.pdf
Psychology School transcription.pdf

Professional experience
Upload a copy of your most recent résumé (CV) outlining previous work experience.

Documents:
Guitar Teaching Certification.pdf
Music Transcript for attending college.pdf

English Language Competency

Select one of the following tests or other qualifications that show you meet our English language requirements. If you have not
uploaded a transcript or test result that provides evidence of meeting the requirement upload it here.

Type: FOUNDATION
Test Type: Other Foundation Program

The University of Western Australia M353, Perth T +61 8 6488 2477 E admissions@uwa.edu.au
WA 6009 Australia www.study.uwa.edu.au CRICOS: 00126G
PRV12169, AUSTRALIAN UNIVERSITY
 25 January 2024
Page 3 of 4

Completion Status: Completed

Completion date: 04/03/2014
Grade/Score: B
Documents:
Preliminary TESOL.pdf

Personal details
Enter your personal details, citizenship and address information.

Personal details
Enter your personal details

Title: Mr
Name order: Given Name, Family Name
Given name: Dwi Atmoko Agung
Family name: Nugroho
Other given names:
Preferred name: Moko
Previous family name: Nugroho
Preferred email address: mokonugroho28@gmail.com
Preferred contact number: +6287884563688
Date of birth: 28 December 1982
Gender: Male
UWA Student Id:
Citizenship: HUMANITARIAN VISA HOLDER
Citizenship country: Indonesia

Address details
Enter your home address details.

Country: Indonesia
Address Line 1: Jl. Teguh II no 130 Kodamar TNI AL Kelap
Address Line 2:
Suburb/Town: Jakarta utara
State: DKI Jakarta
Postcode: 14240

The University of Western Australia M353, Perth T +61 8 6488 2477 E admissions@uwa.edu.au
WA 6009 Australia www.study.uwa.edu.au CRICOS: 00126G
PRV12169, AUSTRALIAN UNIVERSITY
 25 January 2024
Page 4 of 4

Personal details – Additional questions

Please provide the following information

Heritage Declaration
Are you Australian Aboriginal and/or Torres Strait Islander? No

Citizenship (Proof of)

Please upload your Proof of Citizenship. The file cannot be larger than 15MB

Pasport.pdf
3. KTP.pdf

Review and submit

Declaration
I declare that I have read and understood all information, including the requirements for English Language Competence.
I declare that the information provided by me in connection with this application is true and complete.
I understand that UWA reserves the right to vary or reverse any decisions regarding admission or enrolment made on the basis of
incorrect or incomplete information provided by me, and that any such act on my part will be placed on record and will form part of
confidential information forwarded to selectors in assessing any subsequent applications.
I authorise UWA to make enquiries of, and to obtain official records from, any university and tertiary educational institution
concerning my current or previous attendance which, in its absolute discretion, it believes are necessary to be made or obtained and,
if necessary, seek academic information or transcripts. Where necessary QualSearch will be engaged to access this academic
information. I understand that UWA is not responsible if any educational body/institution does not supply these records. I
understand that the result of the search will be made available to me on request and that an audit of this authority may also be
undertaken.
I agree to obey the statutes, regulations and rules of UWA as far as they may apply to me. I declare that the information I have
submitted with this application is a true and complete record of all academic results I have achieved at each and every university
and tertiary educational institution which I have attended and I acknowledge that my failure to disclose my true and complete
tertiary academic record, the provision of incorrect information or the withholding of relevant information, may result in the
cancellation of my enrolment at any stage, and that this action may be recorded on my student file. I will inform UWA immediately
of any change to my contact details.
I understand that the University's authority to collect the information on this form is given by the Higher Education Support Act
2003; that the information is collected to allow the University to properly administer its course programmes; that the information
may be shared for these purposes between the Australian Taxation Office and the Department of Industry, Innovation Science,
Research and Tertiary Education and that the information collected may be disclosed without my consent only as authorised or
required by that Act or another law.

Submission details
Submitted on: 25 January 2024 1:18am
Submitted by:

The University of Western Australia M353, Perth T +61 8 6488 2477 E admissions@uwa.edu.au
WA 6009 Australia www.study.uwa.edu.au CRICOS: 00126G
PRV12169, AUSTRALIAN UNIVERSITY