UNIVERSITY OF LAMPUNG APPLICATION FORM FOR DOCTORAL PROGRAM Web Site 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 MAJOR /DEPARTMENT * STUDY PROGRAM * GRADUATION YEAR * NAME OF UNIVERISTY * ADDRESS OF THE UNIVERSITY * PROGRAM TO APPLY PROGRAMS * Economic Scientific Field Management Scientific Field Law Science Mathematic and Natural Sciences Doctor in Education Development Study Agricultural, Science, and 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 THE UNIVERSITY * 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) * Minimum GPA 3.24 of 4.00 Master Degree Certificate * Max. 2 MB 4x6 color photograph * Max. 2 MB Research Idea for Dissertation * 2500 words (PDF Version) Research or scientific publication that have been published * In PDF version TOEFL Attachment of the certificate min. 173 (CBT) TIBA (Indonesian Proficiency Test) *Exception for Faculty of Economic and Business Information Summary
