UNIVERSITY OF LAMPUNG

 APPLICATION FORM FOR UNDERGRADUATE DEGREE

Email

BIODATA

Title

Choose One Mr. Ms. Mrs. Dr. Prof.

FULL NAME

GENDER/SEX *

MARITAL STATUS *

DATE OF BIRTH *

PLACE OF BIRTH *

EMAIL *

PASSPORT NUMBER *

PASSPORT ISSUANCE DATE *

PASSPORT EXPIRED *

UPLOAD PASSPORT

PDF/JPG

COUNTRY *

EMBASSY NAME *

Indonesian Embassy in your Country. Ex: KBRI Bangkok

NATIONALITY *

HOME ADDRESS *

CITY *

PROVINCE/STATE *

POSTAL CODE *

PHONE/MOBILE NUMBER *

EMERGENCY CONTACT NAME *

RELATIONSHIP *

FAHTER MOTHER WIFE HUSBAND PARTNER

EMERGENCY CONTACT NUMBER *

EMAIL OF THE EMERGENCY CONTACT *

GRADUATED SCHOOL

GRADUATION YEAR *

NAME OF SCHOOL *

ADDRESS OF THE SCHOOL *

PROGRAM TO APPLY

PROGRAMS *

Accounting Management Agribusiness Agronomy Agro-technology Counseling Service Biology Aquaculture Development Economics Physics International Relations Business Administration State Administration Architectural Studies Law Science Marine Science Computer Science Communication Studies Public Administration Soil Science Forestry Chemistry Management Mathematics Animal Feed Science and Technology Indonesian Literature and Language Education English Education French Education Biology Education Medicine Education Economics Education Physics Education Geography Education Early Childhood Education Elementary Teacher Education Sports, Health, and Recreation Education Chemistry Education Mathematics Education Music Education Pancasila and Citizenship Education History Education Dance Education Information and Technology Education Agricultural Extension Animal Husbandry Plant Protection Sociology Aquatic Resources Electrical Engineering Geodesy Engineering Geophysical Engineering Informatics Engineering Chemical Engineering Mechanical Engineering Agricultural Engineering Civil Engineering Agricultural Product Technology

LENGTH OF STUDY *

FINANCIAL SPONSOR *

SELF FUNDING UNILA'S SCHOLARSHIP OTHERS

OTHER SCHOLARSHIP

Name of the scholarship

REFERENCE

NAME OF REFERENCE *

RELATION TO APPLICANT *

Ex: Lecturer, The chief of mastering study program

ADDRESS *

PHONE/MOBILE NUMBER *

EMAIL *

REFERENCE LETTER FROM THE EMBASSY *

Ex: Embassy of Thailand in Jakarta

REFERENCE LETTER FROM SCHOOL *

You have to download the format first at this link: http://io.unila.ac.id/download/reference-letter/

Curriculum vitae *

Max. 2 MB

Academic Transcript (English Version) *

Graduated School Certificate *

Max. 2 MB

4x6 color photograph *

Max. 2 MB

TOEFL *

Attachment of the certificate min. 173 (CBT)

BIPA (Indonesian Proficiency Test) *

Attachment of the certificate minimum score 4

Information Summary