7/21/2019 409 Undergraduate Admission Manual 1308141037
1/27
7/21/2019 409 Undergraduate Admission Manual 1308141037
2/27
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
MESSAGE FROM RECTOR
i
Welcome to UPH Global Campus,Selamat datang di UPH Global Campus,
This Admission Manual Book has been prepared to provide you with comprehensive informaon
regarding UPH Faculty, Double Degree Program, Dual Degree Program, admission requirements and
procedures and financial regulaon.Buku Manual Admission ini dipersiapkan secara menyeluruh mencakup informasi yang berkaitan dengan fakultas dan
jurusan di UPH, Program Double Degree, Program Dual Degree, prosedur dan persyaratan pendafaran serta peraturan
keuangan.
We are eager to have you in the UPH family and introduce you to the vision of our university, which
is: True Knowledge, Faith in God and Godly Character.Kami ingin Anda dapat bergabung dengan kami dan memperkenalkan Anda tentang visi UPH, yaitu: True Knowledge,
Faith in God and Godly Character.
UPH is commied in serving you in the best possible ways, providing a holisc educaon and learning
with an internaonally qualified lecturers and professors, world-class facilies, technology, and
infrastructure. UPH also prepares students to be globally respected and appreciated by modern
industries and businesses.UPH berkomitmen melayani Anda dengan cara yang baik, menyediakan pendidikan serta pengajaran holisk, dengan
pengajar, teknologi dan infrastruktur berkualitas internasional. UPH juga mempersiapkan mahasiswa agar dapat bersaing
secara global di bidang industri dan bisnis modern.
I welcome you to UPH, Global Campus in Indonesia where learning is fun and excellent holisc
educaon is open to you.Selamat datang di UPH, Global Campus di Indonesia yang menyediakan pembelajaran menarik dengan pendidikan holisk
terbaik.
Lippo Village, May 20th2013
Dr. (Hon) Jonathan L. Parapak, M.Eng.Sc.
Chancellor / Rector
7/21/2019 409 Undergraduate Admission Manual 1308141037
3/27
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
TABLE OF CONTENT
ii
Message from Rector
Table of Content
Admission & Scholarship Schedule
Undergraduate Program
Entry Opon
Admission Process
Admission Statement Specimen
Admission Requirement & Addional Requirement for Scholarship
Form Receipt
Admission Statement
Scholarship Applicaon Form
Art & Sport Scholarship Recommendaon Form
Faculty of Medicine Applicaon Form
Conservatory of Music Applicaon Form
Full-English Classes Applicaon Form
New Student Re-Registraon Form
Admission Test Regulaon
Admission Form Guidelines
Table
i
ii
1
2 - 3
4
5
6
7 - 8
9
11
13
14
15
17
19
21
23
24
26
UNIVERSITASPELITAH
ARAPAN
ADMISSION&SCHOLARSH
IPSCHEDULE
GlobalPerspectve.GlobalCampus.
1
ADMISSIONSCHEDULE
Month
Term
Gelombang
August
2013
October
2013
January
2014
September
2013
November
2013
December
2013
February
2014
March
2014
April
2014
May
2014
June
2014
July
2014
EarlyAdmission1
GelombangPendafaranAwalI
DirectAdmissionSubmissio
nDeadline
Batasakhirpendafa
ran
AdmissionTest
UjianSaringanMas
uk
DirectAdmissionSubmissio
nDeadline
Batasakhirpendafa
ran
AdmissionTest
UjianSaringanMas
uk
DirectAdmissionSubmissio
nDeadline
Batasakhirpendafa
ran
AdmissionTest
UjianSaringanMas
uk
DirectAdmissionSubmissio
nDeadline
Batasakhirpendafa
ran
AdmissionTest
UjianSaringanMas
uk
DirectAdmissionSubmissio
nDeadline
Batasakhirpendafa
ran
AdmissionTest
UjianSaringanMas
uk
DirectAdmissionSubmissio
nDeadline
Batasakhirpendafa
ran
AdmissionTest
UjianSaringanMas
uk
DirectAdmissionSubmissio
nDeadline
Batasakhirpendafa
ran
AdmissionTest
UjianSaringanMas
uk
OutsideJabodetabek
GelombangLuarKota
EarlyAdmission2
GelombangPendafaranAwalII
Term1
Gelombang1
Term2
Gelombang2
Term3
Gelombang3
Term4
Gelombang4
No
01
02
03
04
05
06
07
28Sept
12Oct
23Nov
7Dec
14Dec
14Dec
24Jan
8Feb
14Mar
9May
24May
27Jun
12Jul
29Mar
SCHOLARSHIPSCHEDULE
Month
Term
Gelombang
August
2013
October
2013
January
2014
September
2013
November
2013
December
2013
February
2014
March
2014
April
2014
May
2014
June
2014
July
2014
ScholarshipTerm1
Pendafaran
BeasiswaTahap1
ScholarshipTerm2
Pendafaran
BeasiswaTahap2
ScholarshipFacultyof
MedicineTerm1
Pendafaran
BeasiswaFakultasKedokteran
Tahap1
ScholarshipFacultyof
MedicineTerm2
Pendafaran
BeasiswaFakultasKedokteran
Tahap2
DirectAdmissionSubmissio
nDeadline
Batasakhirpendafa
ran
InterviewSession
SesiWawancara
Announcement
Pengumuman
DirectAdmissionSubmissio
nDeadline
Batasakhirpendafa
ran
InterviewSession
SesiWawancara
Announcement
Pengumuman
DirectAdmissionSubmissio
nDeadline
Batasakhirpendafa
ran
AdmissionTest
UjuanSaringanMasuk
InterviewSession
SesiWawancara
Announcement
Pengumuman
DirectAdmissionSubmissio
nDeadline
Batasakhirpendafa
ran
AdmissionTest
UjuanSaringanMasuk
InterviewSession
SesiWawancara
Announcement
Pengumuman
No
01
02
03
04
20Sept
22Nov
5Oct
21-25Oct
2Oct
21Oct
1Nov
15-22Nov
5Feb
8Feb
17-21Feb
3Dec
14Mar
20Sept-4Oct
Datesaresubjecttochange,pleasev
isitwww.uph.edu|Tanggaldapatberubahsewaktu-waktu,lihatwww.uph.eduuntuktanggalterbaru.
7/21/2019 409 Undergraduate Admission Manual 1308141037
4/27
2
UNIVERSITAS P
UNDERGRADUGlobal Perspecve. Global Campus.
Management Available
English & Mathemacs
English & Mathemacs
Bussiness School
FACULTY MAJOR FULL ENGLISH CLASS ADMISSION TEST SUBJECTSINGLE DEGREE
TOTALTERM/
SEMESTER*
DEGREE
9 S.E.
Accounng Available 9 S.E.
School of Design (SoD)
English, Mathemacs & Drawing
English, Mathemacs & Drawing
English, Mathemacs & Drawing
English, Mathemacs & Drawing
Not Available 11 - 12Architecture
Not Available 9 - 11
S.Ars.
Visual Communicaon Design
Available 9 - 11 S.Sn.
S.Sn.
Interior Design
Not Available 9 - 11 S.Sn.Product Design
Faculty of Science and Technology
(FaST)
S.T.PFood TechnologyEnglish, Mathemacs, Biology &
Chemistry10Available
10
English, Mathemacs & PhysicsCivil Engineering Not Available 10 S.T.
Faculty of Social and Polical Science
(FISIP)
English & Mathemacs
English & Mathemacs
School of Applied Communicaon
SciencesAvailable 9 S.I.Kom
School of Government and
Global AffairsAvailable 9 S.Sos.
Faculty of Computer Science (FIK)
English & Mathemacs
English & Mathemacs
English & Mathemacs
Informaon system Not Available 9 S.SI.
Informacs Not Available 9 S.Inf.
Computer System Not Available 9 S.Kom.
School of Hospitality and Tourism
(STPPH)
English & Tourism KnowledgeHospitality Management Available 9 S.S.T.Par.
English & Tourism KnowledgeTr av el In du st ry Ma na ge me nt N ot A va il ab le 9 S.S.T.Par.
School of Law (FH) English & MathemacsLaw Available 9 S.H.
Conservatory of Music Music Not Available 9 - 11 S.Sn.Not Available
Faculty of Medicine (FK)English, Mathemacs, Biology &
ChemistryMedicine Not Available 10* dr.
Faculty of Educaon (FIP) Teachers College
**Get S.Kep.Ns. with addional 2 semesters
English Educaon, Primary Educaon,
Biology Educaon, Economics Educaon,
Mathemacs Educaon
Available 8* S.Pd.
Faculty of Psychology (F.Psi) English & MathemacsPsychology Not Available 9 S.Psi.
Faculty of Nursing and Allied Health
Sciences (FoN)PsikotestNursing Not Available 9 S.Kep.**
English, Mathemacs & PhysicsElectrical Engineering S.T.Not Available 10
English & Mathemacs S.Si.Not AvailableApplied Mathemacs 10 . . .
. .
S.Si.Not AvailableBiotechnologyEnglish, Mathemacs, Biology &
Chemistry
English, Mathemacs & Physics S.T.Industrial Engineering Not Available 10
3
LITA HARAPAN
TE PROGRAM
DOUBLE DEGREE DUAL DEGREE
Joint Degree: UPH (S.E) & Royal Melbourne Instute of Technology Melbourne Australia (Bachelor of Business (Accountancy))Informaon System (S.SI.) &
Accounng (S.E.)
Food, Technology, Computer System,AppliedMathe macs, Hospitality Mgt.&
TravelIndustry Mgt.
Check onmajors below: UPH(S.E.)&LaTrobe University, Melbourne -Australia(Bachelor ofBusiness/Bachelor ofInternaonalBusiness)
UPH(S.E) &Royal Melbourne Instute ofTechnology (RMIT)Melbourne Australia(B.Bus )
Joint Degree: UPH(S.E) &Royal Melbourne Instute ofTechnology Melbourne Australia(Bachelor ofBusine ss(Manageme nt))
Joint Degree: UPH(S.E) &Royal Melbourne Instute ofTechnology Melbourne Australia(Bachel or ofBusine ss(Markeng))
Not AvailableNot Available
Not Available
Not Available
Not Available
Not Available
Not Available
UPH (S.Sn.) & Queensland University of Technology, Brisbane - Australia (Bachelor of Design)
Food Technology (S.T.P.) &Management (S.E.)
UPH (S.T.P.) & University of Newcastle, New South Wales - Australia (Bachelor of Food Science and Human Nutrion)
Not Availabl e UPH (S.T.) & Hanzehoges chool Groningen, Nether land (C iviele Techniek Ingenie ur)
Not Available
Not Available
UPH (S.E) & Royal Melbourne Instute of Technology (RMIT) Melbourne Australia Bachelor of Communicaon (Professional Communicaon)
Not Available
Informaon System (S.SI.) &Accounng (S.E.)
Informacs (S.Inf) &Applied Mathemacs (S.Si.)
Computer System (S.Kom) &
Management (S.E.)
Not Available
Not Available
Not Available
Hospitality Management (S.S.T.Par.) &
Management (S.E)
Travel Industry (S.S.T.Par.) &Management (S.E)
Not Available
UPH (S.ST.Par) & Internaonal College of Hotel Management, Adelaide - Australia (Bachelor of Hotel Management) UPH (S.ST.Par) & Internaonal Hotel
Management Instute, Lucerne - Switzerland (Bachelor of Arts)
UPH (S.H.) & Murdoch University, Perth - Australia (Bachelor of Common Law)Not Available
Not AvailableNot Available
Not AvailableNot Available
For Admission Requirement and further informaon, please call 021.546057 ext.2613/2637 or email [email protected]
Not AvailableNot Available
Not AvailableNot Available
Not Available Not Available
Applied Mathemacs(S.Si) &Informacs (S.Inf.)
Applied Mathemacs(S.Si) &Management (S.E)Not Available
Not Available Not Available
Not Available Not Available
7/21/2019 409 Undergraduate Admission Manual 1308141037
5/27
7/21/2019 409 Undergraduate Admission Manual 1308141037
6/27
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
ADMISSION STATEMENT
6
Place Tempat Date
,
Tanggal
Please sign on the stamp/Harap tanda tangan mengenai materai.
PARENT/GUARDIANS FULL NAME & SIGNATURE PROSPECTIVE STUDENT S SIGNATURE & FULL NAME
Stamp Duty/
Materai
Rp. 6000,-
READ CAREFULLY BEFORE YOU SIGN!
Bacalah dengan seksama sebelum Anda menandatangani!
This Admission Statement is an agreement between Prospecve Students and UPH/STPPH as an instuon.Pernyataan Pendaaran adalah perjanjian antara mahasiswa Calon dan UPH/STPPH sebagai sebuah instusi.
Form Number :Nomor Formulir
Full Name :Nama Lengkap
I, the undersigned below
Saya, yang bertanda tangan di bawah ini,
Hereby affirm that,
dengan ini menegaskan bahwa,
1. I will not in any conduct against the law; bring, consume, and/or distribute illegal drugs or alcoholic drinks. The right to be a student of UPH/STPPH
will be denied should I fail the health examinaon/drug examinaon.
Tidak akan melakukan semua perbuatan yang melanggar hukum; membawa, mengkonsumsi serta mengedarkan obat terlarang (Narkoba)/minuman
keras. Hak sebagai mahasiswa UPH/STPPH akan gugur bila dak lulus dalam tes kesehatan/tes narkoba.
2. I am not color blind (for Medicine & Design Major) proved by Cerficate of Color Blind.
Saya dak buta warna (khusus Kedokteran & Design) dibukkan dengan Surat Keterangan Tidak Buta Warna.
3. I am willing to parcipate in a blood/urine examinaon at any given me by UPH/STPPH.
Bersedia melakukan tes darah/urine yang sewaktu-waktu akan dilakukan oleh pihak UPH/STPPH.
4. The educaon program of UPH/STPPH is characterized by the Chrisan Faith, based on the Pancasila and UUD 1945.
Mengetahui bahwa penyelenggaraan pendidikan di UPH/STPPH bercirikan iman Krisani dan berdasarkan Pancasila & UUD 1945.
5. For Faculty of Psychology : I acknowledge and agree to follow the curriculum in Faculty of Psychology, that is enriched with Chrisan values.
I am fully aware that there will be Individual counseling as a prerequisite to connue the study into the next semester (Semester 2).
Untuk Fakultas Psikologi : Saya mengetahui dan menyetujui untuk mengiku pembelajaran di Psikologi Universitas Pelita Harapan yang diperkaya
dengan nilai-nilai Krisani. Saya menyadari sepenuhnya bahwa akan ada konseling pribadi sebagai persyaratan untuk melanjutkan pembelajaran
semester berikutnya (Semester 2).
6. I am ready to be dismissed from UPH/STPPH if at the end of the first 4 semesters I have not yet reached at least 40 credits and have a GPA
7/21/2019 409 Undergraduate Admission Manual 1308141037
7/27
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
ADDITIONAL REQUIREMENT FOR SCHOLARSHIP
8
DOCUMENTS
DOCUMENTS
AcademicAchievement
Category
LimitedFinancialCategory
ArtAchievement
Category
SportAchievement
CategoryNo
1 Scholarship Applicaon Form (Admission Manual page 13)
A copy of Family Card/KK
A-500-word English Essay about:
Why I choose X Major at UPH as a Steping Stone for My Career
A copy of Parents payslip of income
A statement leer of family financial condion, issued by: Church (for
Chrisan/Catholic) or RT/RW/Kelurahan (for non Chrisan/Catholic)
A copy of electricity bill for the last 3 months
A copy of water bill for the last 3 months
A copy of land telephone bill for the last 3 months
A copy of the last Pajak Bumi dan Bangunan(PBB) Tax payment
Scholarship Recommendaon Form (Admission Manual page 14)
A copy of cerficate in respecve field
A recent photo (postcard size) for sport using team uniforms (write
your name, height and weight behind the photo)
A copy of cerficate of performance (province/naonal/internaonal
level)
Recommendaon Leer from Komite Olahraga Naonal Indonesia (KONI)
2
3
4
5
6
7
8
9
10
11
12
13
14
For further informaon about Scholarship Program, please see www.uph.edu/admission/undergraduate-scholarship.html
Prospecve Students Informaon
Form Number :Nomor Formulir
Full Name :Nama Lengkap
School Name, City :Nama Sekolah, Kota
Copy 2 : Admission Office
Entry Opon Please give ck (v) in your opon Silahkan berikan tanda (v) pada pilihan Anda
Direct Admission
Admission Test
Scholarship - Direct Admission
Scholarship - Admission Test ( Only for Faculty of Medicine)
Preference Major
1stMajor
Code : Code : Code :
2ndMajor 3rdMajor
Major Nama Jurusan : Major Nama Jurusan : Major Nama Jurusan :
Place
Applicant Signature & Full NameTandatangan & Nama Lengkap Calon Mahasiswa
Tempat Date
,
Tanggal
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
FORM RECEIPT
Phone Number :Nomor Telephone
Mobile Phone :Nomor Hp
Prospecve Students Informaon
Form Number :Nomor Formulir
Full Name :Nama Lengkap
School Name, City :Nama Sekolah, Kota
Copy 1 : Prospecve Students
Entry Opon Please give ck (v) in your opon Silahkan berikan tanda (v) pada pilihan Anda
Direct Admission
Admission Test
Scholarship - Direct Admission
Scholarship - Admission Test ( Only for Faculty of Medicine)
Preference Major
1stMajor
Code : Code : Code :
2ndMajor 3rdMajor
Major Nama Jurusan : Major Nama Jurusan : Major Nama Jurusan :
Place
Admission Staff Signature & Full NameTandatangan & Nama Lengkap Staf Admisi
Tempat Date
,
Tanggal
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
FORM RECEIPT
Guntngdisini
Gunng disini
,
,
7/21/2019 409 Undergraduate Admission Manual 1308141037
8/27
Guntngdisini
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
ADMISSION STATEMENT
11
Place Tempat Date
,
Tanggal
Please sign on the stamp/Harap tanda tangan mengenai materai.
PARENT/GUARDIANS FULL NAME & SIGNATURE PROSPECTIVE STUDENT S SIGNATURE & FULL NAME
Stamp Duty/
Materai
Rp. 6000,-
READ CAREFULLY BEFORE YOU SIGN!
Bacalah dengan seksama sebelum Anda menandatangani!
This Admission Statement is an agreement between Prospecve Students and UPH/STPPH as an instuon.Pernyataan Pendaaran adalah perjanjian antara mahasiswa Calon dan UPH/STPPH sebagai sebuah instusi.
Form Number :Nomor Formulir
Full Name :Nama Lengkap
I, the undersigned below
Saya, yang bertanda tangan di bawah ini,
Hereby affirm that,
dengan ini menegaskan bahwa,
Copy 2 : Admission Office
1. I will not in any conduct against the law; bring, consume, and/or distribute illegal drugs or alcoholic drinks. The right to be a student of UPH/STPPH
will be denied should I fail the health examinaon/drug examinaon.
Tidak akan melakukan semua perbuatan yang melanggar hukum; membawa, mengkonsumsi serta mengedarkan obat terlarang (Narkoba)/minuman
keras. Hak sebagai mahasiswa UPH/STPPH akan gugur bila dak lulus dalam tes kesehatan/tes narkoba.
2. I am not color blind (for Medicine & Design Major) proved by Cerficate of Color Blind.
Saya dak buta warna (khusus Kedokteran & Design) dibukkan dengan Surat Keterangan Tidak Buta Warna.
3. I am willing to parcipate in a blood/urine examinaon at any given me by UPH/STPPH.
Bersedia melakukan tes darah/urine yang sewaktu-waktu akan dilakukan oleh pihak UPH/STPPH.
4. The educaon program of UPH/STPPH is characterized by the Chrisan Faith, based on the Pancasila and UUD 1945.
Mengetahui bahwa penyelenggaraan pendidikan di UPH/STPPH bercirikan iman Krisani dan berdasarkan Pancasila & UUD 1945.
5. For Faculty of Psychology : I acknowledge and agree to follow the curriculum in Faculty of Psychology, that is enriched with Chrisan values.
I am fully aware that there will be Individual counseling as a prerequisite to connue the study into the next semester (Semester 2).
Untuk Fakultas Psikologi : Saya mengetahui dan menyetujui untuk mengiku pembelajaran di Psikologi Universitas Pelita Harapan yang diperkaya
dengan nilai-nilai Krisani. Saya menyadari sepenuhnya bahwa akan ada konseling pribadi sebagai persyaratan untuk melanjutkan pembelajaran
semester berikutnya (Semester 2).
6. I am ready to be dismissed from UPH/STPPH if at the end of the first 4 semesters I have not yet reached at least 40 credits and have a GPA
7/21/2019 409 Undergraduate Admission Manual 1308141037
9/27
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
SCHOLARSHIP APPLICATION FORM
13
SCHOLARSHIP APPLICATION FOR ALL CATEGORIES
Social, Organizaonal or Leadership Acvies at school.Akvitas sosial, organisasi atau kepemimpinan di sekolah.
Achievements (Senior High School Level).Penghargaan yang pernah diperoleh (di ngkat SMA).
Scholarship Apply Jalur Beasiswa
(please aach cerficates that support this informaon)(lampirkan fotokopi serfikat sebagai buk yang mendukung informasi ini)
Religious Acvies in Church.Akvitas keagamaan di gereja.
If you are Chrisan/Catholic, please fill here:Jika Anda beragama Kristen/Katolik, harap isi keterangan berikut ini:
Church :Nama Gereja
Address :
Alamat Gereja
Join ministry/acvies :Mengiku kegiatan pelayanan
Form Number :Nomor Formulir
Full Name :Nama Lengkap
Place | Tempat
PARENT/GUARDIANS FULL NAME & SIGNATURE
Date | Tanggal
,
PROSPECTIVE STUDENTS SIGNATURE & FULL NAME
I, the undersigned below,Saya, yang bertanda tangan di bawah ini,
Please give ck (v) in your opon Silahkan berikan tanda (v) pada pilihan Anda
Academic AchievementPrestasi Akademik
Limited FinanceKondisi Ekonomi Terbatas
Art AchievementPrestasi Seni
Sport AchievementPrestasi Olahraga
I affirm the above informaon is true.Saya tegaskan informasi di atas adalah benar.
Guntngdisini
7/21/2019 409 Undergraduate Admission Manual 1308141037
10/27
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
ART & SPORT SCHOLARSHIP RECOMMENDATION FORM
14
I, the undersigned belowSaya, yang bertanda tangan di bawah ini,
Coach/Teacher full name :Nama Lengkap Pelah/Guru
Coach/Teacher of :Pelah / Guru
ART
SPORT
Guitar
Bass
Keyboard
Drum
Piano
Choir
Vocal
Modern Dance
Tradional Dance
Theatre Other,
Basketball Volleyball Soccer Swimming Badminton
Photography
Video Eding
Coach/Teacher of :Pelah / Guru
Recommend this Prospecve Student regarding his/her scholarship applicaon:Merekomendasikan Calon Mahasiswa ini pada pendafaran Program Beasiswa:
Recent Photograph (Postcard Size)Foto terbaru (Ukuran Postcard)
High School/Instuon :Sekolah/Instusi
Phone Number & Mobile Phone :Nomor Telepon & Nomor HP
Place
I affirm the above informaon is true.Saya tegaskan informasi di atas adalah benar.
Signature & Full Name + Stamp (if any)Tandatangan & Nama Lengkap + Cap (Jika ada)
Tempat Date
,
Tanggal
Form Number :Nomor Formulir
Full Name :Nama Lengkap
Height :Tinggi Badan
kgcm Weight :Berat Badan
Playing Posion in Team :Posisi pada m
Coach/Teacher of :Pelah / Guru
FOR ART AND SPORT SCHOLARSHIP APPLICANT
Guntngdisini
1. 2. 3.
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
FACULTY OF MEDICINE APPLICATION FORM
15
Prospecve Students Informaon
Community Involvement
Please provide a brief summary of all volunteering, caring, community leadership, religious services and organizaons that you have parcipated.
Jelaskan secara singkat semua bentuk parsipasi Anda pada kegiatan relawan, kepemimpinan, pelayanan keagamaan dan organisasi.
Personal Achievement
Personal Statement
Please aach a-500-word English Essay about Why I am interested in
Medicine and how I will use it to provide good health care for the people of
Indonesia in the future.
Lampirkan-500-kata esai Bahasa inggris tentang Mengapa saya tertarik
pada Kedokteran dan bagaimana saya akan menggunakannya untuk
memberikan perawatan kesehatan yang baik bagi masyarakat Indonesia di
masa depan.
Please provide a brief summary of current sports, arsc, hobbies and interest.
Jelaskan secara singkat tentang kegiatan olahraga, seni, hobi dan minat Anda saat ini.
Form Number :Nomor Formulir
Full Name :Nama Lengkap
FOR FACULTY OF MEDICINE APPLICANT
Place & Date of Birth Tempat & Tanggal Lahir :
Name of Parent Nama Orang Tua :
Name of Family Doctor Nama Dokter Keluarga :
Place
Prospecve Student,Calon Mahasiswa
Signature & Full NameTandatangan & Nama Lengkap
Tempat Date
,
Tanggal
Guntngdisini
7/21/2019 409 Undergraduate Admission Manual 1308141037
11/27
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
CONSERVATORY OF MUSIC APPPLICATION FORM
17 FOR CONSERVATORY OF MUSIC APPLICANT
Form Number :Nomor Formulir
Full Name :Nama Lengkap
School Name :Nama Sekolah
Chosen Consentraon ( Put Rank 1st, 2ndand 3rdbased on priority)Konsentrasi Pilihan (Pilih berdasarkan prioritas 1, 2 dan 3)
Chosen major instrument: (Please ck one only)Instrument Pilihan: (Pilih satu saja)
Church Music*
Classical Performance
Music Educaon: Individual Teaching
Music Educaon: School Teaching
Music Therapy
Music Composion**
Performing Art and Producon Management
Professional Contemporary Performance
Sound Design
Other, ______________________________
Bass
Cello
Flute
Guitar
Drum
Piano
Saxophone
Violin
Vocal
Other, _________
Why do you choose UPH Conservatory of Music?Mengapa Anda memilih Conservatory of Music UPH?
Why do you choose 1st choice concentraon?Mengapa Anda memilih pilihan konsentrasi pertama?
Why do you choose 2nd choice concentraon?Mengapa Anda memilih pilihan konsentrasi kedua?
Why do you choose 3rd choice concentraon?Mengapa Anda memilih pilihan konsentrasi kega?
How does music bring impact to your life.Deskripsikan bagaimana misik memberi dampak bagi hidup Anda.
Who is your favorite composer or performer? Why?Siapa composer?performer favorit Anda? Mengapa?
Ensemble playing experiences: Yes/NoApakah Anda pernah memainkan ensemble? Ya/Tidak
Apply to Conservatory of Music other than UPH? Yes/NoApakah Anda mendaar ke jurusan Musik lain selain di UPH? Ya/Tidak.
Lastest teacher name :
Instuon/music schools :
Music award ever received (if any) :
Menon the repertoire that you have ever learned?Sebutkan repertoire yang pertama Anda pelajari?
Briefly, describe your goal and influence that make you planning a career in music.Jelaskan secara singkat mengenai tujuan dan dampak yang Anda dapat berikan saat berkarir di bidang musik.
Student recent photo
3x4Foto terbaru Calon Mahasiswa
3x4
1. Student complete the data of Student Informaon.
2. Check the admission requirement and procedure at www.music.uph.edu
3. Applicants for all concentraons should submit a good DVD/VCD quality recording which contains three
contrasng pieces.
4. Applicants may be asked for Music Placement Test (Music Theory and Solfeggio).
5. The Recommender completes tha data of recommender.
INSTRUCTION
Guntngdisini
* Available majors: Piano, Vocal & String
** Available majors: Piano, Voice, Guitar, Bass, Percussion & Drum
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
HEALTH DECLARATION FORM
16
Form Number :Nomor Formulir
Full Name :Nama Lengkap
I, the undersigned below
Saya, yang bertanda tangan di bawah ini,
If you are accepted as a student of the Faculty of Medicine, you will be required to complete the Health Declaraon Form prior to joining for your classes.
The informaon provided to us is confidenal and will not be used for any other purposes except providing support for the student.Jika Anda diterima sebagai mahasiswa Fakultas Kedokteran, Anda akan diminta untuk melengkapi Formulir Pernyataan Kesehatan sebelum bergabung di dalam kelas. Informasi yang diberikan kepada kami
bersifat rahasia dan dak akan digunakan untuk tujuan lain kecuali memberikan dukungan bagi siswa.
No
No
1Do you have, or have you ever had, any medical condions or operaons in the past 5 years?Apakah Anda memiliki, atau apakah Anda pernah punya, kondisi atau operasi dalam 5 tahun terakhir?
Have you ever suffered from tuberculosis (TB) within the past 12 months?Apakah Anda pernah menderita tuberkulosis (TB) dalam 12 bulan terakhir?
Has any family member or close contact been treated for TB?Apakah ada anggota keluarga atau kontak dekat dirawat karena TBC?
Have you had a cough for more than 3 weeks?Apakah Anda memliki batuk selama lebih dari 3 minggu?
Have you coughed up blood?Apakah Anda pernah batuk berdarah?
Have you had any unexplained weight loss?Apakah Anda punya berat badan yang dak dapat dijelaskan?
Have you suffered from night sweats or fever?Apakah Anda menderita keringatan malam atau demam?
Have you ever had any kind of back, joint or muscle problem?Apakah Anda memiliki sakit punggung, sendi atau masalah otot?
Have you ever had, Dermas, Eczema, Psoriasis or any other skin condion?Apakah Anda pernah mengalami: Dermas, Eksim, Psoriasis atau kondisi kulit lainnya?
Have you ever had a drug, tobacco, nicone or alcohol problem?Apakah Anda pernah memiliki masalah narkoba, tembakau, nikon atau alcohol?
Do you have any difficulty with your eyesight, including color blindess?Apakah Anda memiliki kesulitan dengan penglihatan Anda, termasuk buta warna?
Do you have difficulty in hearing?Apakah Anda memiliki kesulitan pendengaran?
Have you ever suffered with chest or lung problems: Asthma, Bronchis?Pernahkah Anda menderita dengan dada atau masalah paru-paru, Asma, Bronchis?
Have you ever had any allergies; including ro drugs, food or latex?Pernahkah Anda punya alergi, termasuk alergi terhadap obat-obatan, makanan atau lateks?
Have you ever received treatment for bowel or gastric problems?Apakah Anda menerima pengobatan untuk usus dan lambung masalah?
Do you have any other medical condions that is not previously menoned in quesons 1 15 above?Apakah Anda memiliki kondisi medis lain yang sebelumnya dak disebutkan dalam pertanyaan 1 15 di atas?
Have you ever suffered from any of the following: loss of consciousness including fainng aacks,
blackouts epilepsy?Pernahkah Anda menderita salah satu dari berikut: kehilangan kesadaran termasuk serangan pingsan, Pemadaman, epilepsi?
Have you ever suffered from any of the following: heart disease, diabetes, Hipertension or any other
medical illness?Pernahkah Anda menderita salah satu dari berikut: penyakit jantung, diabetes, Hipertensi atau penyakit medis lainnya?
Have you ever had any mental illness which might affect your ability to study and pracce medical
science? (including anxiety, depression, self-harm, eang, disorders, psychological or emoonal
problems)pernahkah Anda punya penyakit mental yang dapat mempengaruhi kemampuan Anda untuk belajar dan mempraktekkan ilmu
kedokteran? (termasuk kecemasan, depresi, menyaki diri, makan, gangguan, psikologis atau masalah emosional)
Are you at present aending a doctor for medical care, taking any medicaon or on a waing list for
hospital assessment or treatment?Apakah Anda saat ini menghadiri dokter untuk perawatan medis, mengonsumsi obat-obatan atau pada daar tunggu untuk penilaianrumah sakit atau perawatan?
Do you have impairment/disability (physical or metal) or specific learning disability which may effect
your ability to study in Faculty of Medicine UPH?Apakah Anda memilki kerusakan / cacat (fisik atau mental) atau kedakmampuan belajar tertentu yang dapat mempengaruhi
kemampuan Anda untuk belajar di Fakultas Kedokteran UPH?
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Health Declaraon
Pernyataan Kesehatan
Yes
Ya
No
Tidak
Details
Keterangan
Place
Tempat
DateTanggal
,Signature & Full NameTandatangan & Nama Lengkap
Faculty of Medicine New Students,Mahasiswa Baru Fakultas Kedokteran
I affirm the above informaon is true.
Saya tegaskan informasi di atas adalah benar.
Guntngdisini
7/21/2019 409 Undergraduate Admission Manual 1308141037
12/27
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
CONSERVATORY OF MUSIC RECOMMENDATION FORM
Length of course :Lama belajar
YearTahun
Frequency / week :frekuensi / minggu
course / weeklahan / minggu
Hours / courseJam / lahan
Mobile Phone :Nomor Handphone
1. How is the Technical strength in playing the instrument:
a. solid
b. need supervision to be solid c. difficult to be solid
6. Level of dilligence:
a. Show a great enthusiasm to learn his/her musical pieces
b. has ambion to develop his/her musical ability yet less
consistent c. depends on mood, always need support to gain movaon and
inspiraon
7. Level of speed to grasp the knowledge:
a. Show rapid development in a short amount of me
b. not too fast in showing dilligence to do the work ability by his
her own iniave
c. not too fast and less careful over the given correcon not too
fast and less carefull over the given correcon
8. Your opinion about the maturity of your student: your opinion
about the maturity of your student:
a. able to show his/her maturity, think logically and crical in a
consistent manner
b. able to show his/her maturity yet fail to accomplish
c. immature and need spesial guidance/aenon immature and
need spesial guidance/aenon
9. Level of confidence to see your student will be able to succeed
studying at UPH Conservatory of Music with his/her chosen ritmic
dictaon, melody, interval, and harmony concentraon:
a. very sure 80% - 100%
b. sure 60% - 80%
c. unsure 50% - 60%
10. Your consideraon for the student to get scholarship:
a. Highly recommended
b. recommended
c. less recommended
2. How is the Musical strength in playing the instrument:
a. sensive and able to perform an outstanding musical showing
diligence to do work
b. sensive yet need guidance
c. less sensive
3. Knowledge about Theory of Music:
a. very good in making harmony using S-A-T-B format
b. know basic format is wring S-A-T-B
c. doesnt have a deep knowledge in thepry of music
4. Knowledge about aural training:
a. well trained in solfegio/ prima vista for example: ritmic
dictaon, melody, interval, and harmony.
b. has sufficient session in aural training but only before the
examinaon period.
c. havent received aural training yet
5. Knowledge about history of Music:
a. has interest in learning the history of music as well as
background of songs that he/she is playing
b. has sufficient guidance
c. never receive any guidance
I Recommend this prospecve student regarding his/her applicaon to UPH.Saya, merekomendasikan Calon Mahasiswa ini untuk mendaar di UPH.
I Affirm the above informaon is true.Saya Tegaskan informasi di atas adalah benar.
Full Name :Nama Lengkap
Instuon/ School of Music :Nama Sekolah Music
RECCOMENDER
Perekomendasi
DETAILS OF RECOMMENDATION INFORMASI LENGKAP PEREKOMENDASI
Please circle the most appropriate answer based on prospecve students music skill.Silahkan lingkari jawaban yang paling tepat berdasarkan keterampilan musik mahasiswa calon.
RECOMMENDATION LETTER SURAT REKOMENDASI
We would like to ask your recommendaon of this student regarding his/her applicaon to UPH Conservatory of MusicKami ingin meminta rekomendasi Anda atas pendaaran calon mahasiswa ini di UPH Conservatory of Music
Coach / TeacherPelah / Guru
Place Tempat Date
,
Tanggal
Signature & Full Name + Stamp (if any)Tandatangan & Nama L engkap + Cap (Jika ada)
18
Guntngdisini
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
FULL-ENGLISH CLASSES APPLICATION FORM
19
FORMULIR WAJIB DllSl OLEH MAHASISWA BARU dari jurusan Manajemen, Akuntansi, llmu Komunikasi, Hubungan lnternasional, Hukum,Desain lnterior, Teknologi Pangan dan Manajemen Perhotelan ( Sekolah Tinggi Pariwisata dan Perhotelan Pelita Harapan )THIS FORM REQUIRED TO FILLED BY NEW STUDENTS from Management, Accounng, Communicaon Studies, lnternaonal Relaons, Law, Interior Design, Food Technology and
Hospitality Management (school ol Tourism and Hospitality Pelita Harapan)
Sebagai persyaratan untuk memilih kelas internaonal, maka saya dengan data-data sbb:As the requirements for selecng an internaonal class, I am with the following data:
Nomor Formulir : __________________________ ____________Form Number
Saya, mendaar untuk mengiku kelas dalam bahasa Inggris.I am registering to join Full English Classes
Kelas dalam bahasa Inggris tersedia untuk jurusan Management, Akutansi, Ilmu Komunikasi, Hubungan Internaonal, Hukum, Design Interior, Teknologi Pangan
dan Management Perhotelan ( Sekolah Tinggi Pariwisata dan Perhotelan Pelita Harapan )Full english classes are available for majoring in management,Accounng, Communicaon Studies, Internaonal Relaon, Law, Interior Design, Food Technology and Hospitality
Managements (School of tourism and Hospitality Pelita Harapan)
Saya menger, untuk Kelas yang dibawakan dalam bahasa Inggris, Persyaratan minimum TOEFL 500 harus di penuhi, jika persyaratan TOEFL dak terpenuhi maka
UPH berhak untuk mengalihkan ke kelas regular.I fully understood that Full English Classes require a minimum TOEFL PBT of 500. Should the requirement is not yet met, UPH has the right to make a placement to regular class.
Calon Mahasiswa harus melampirkan serfikat TOEFL IBT atau IELTS atau TOEFL PBT yang asli dan masih berlaku.Prospecve Students must submied a valid & original cerficate of TOEFL IBT or IELTS or TOEFL PBT.
Jika Calon Mahasiswa mempunyai hasil test selain TOEFL PBT, berikut adalah nilai minimum standar penerimaannya:If prospecve students have other than TOEFL PBT Test Result, the following is minimum conversion standard:
TOEFL PBT TOEFL IBT IELTS Status Penerimaan Kelas dalam bahasa InggrisPaper Based Test Internet Based Test Internaonal English Language Tesng System Admission Status
500 59 60 5.0 Diterima | Passed
Jika Calon Mahasiswa baru belum mempunyai TOEFL / IELTS maka dapat melakukan English Test di UPH Language Center, sesuai dengan waktu yang telah
ditentukan. Untuk waktu pelaksanaan English Test di UPH Language Center, silahkan periksa di www.uph.edu dibagian Info Center.If Prospecve Students do not have TOEFL / IELTS, S(he) can take the English Test conducted by UPH Language Center as schedule. Please check at www.uph.edu in Info Center secon for
the schedule.
Mohon menyerahkan formulir ini bersama dengan Formulir Pendaaran. Bagi yang dak mengiku English Test di UPH Language Center harap menyerahkan
fotokopi Serfikat Test TOEFL / IELTS yang masih berlaku paling lambat 27 Juni 2014.
Please submit this form along with Applicaon Form. For those who do not aend the English Test at UPH Language Center, please submit a copy of valid TOEFL/IELTS Cerficatebefore June 27th2014.
Saya mendaar Full English Class dan mengiku English Test di UPH Language Center.I, register Full English Class and English Test at UPH Language Center.
Nama : _________________________ _____________Name
Jurusan : _____________________________ _________Major
Nomor Handphone : _____________________________ _________Phone Number
Saya mendaar Full English Class dan menyerahkan hasil fotokopi test TOEFL/IELTS.I, register Full English Class and submit a copy of TOEFL/IELTS Cerficate.
Saya dak mengiku Full English Class.Iam not register Full English Class.
Tempat | Place, Tanggal | Date
,
( __________________________________ )
Nama Jelas | Complete Name
( __________________________________ )
Nama Jelas | Complete Name
( __________________________________ )
Nama Jelas | Complete Name
Diterima Oleh,
Received by,
Staff Admisi
Admission Staff
Prospecve Student
Calon Mahasiswa
Diverifikasi Oleh,
Verified by,
UPH Language Center
Guntngdisini
7/21/2019 409 Undergraduate Admission Manual 1308141037
13/27
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
NEW STUDENT RE-REGISTRATION FORM
21
Date Tanggal :
FORM
020
GENERAL REQUIREMENTPERSYARATAN UMUM
A copy of High School Final Cerficate legalized by Principal.Fotokopi Ijazah/Surat Tanda Tamat Belajar dilegalisasi oleh Kepala Sekolah.
1 Piece1 Lembar
1 Piece1 Lembar
1 Piece1 Lembar
1 Piece1 Lembar
4 Pieces
4 Lembar
1 Piece1 Lembar
1 Piece1 Lembar
A copy of NEM/STL/STK/SKHUN/TRANSCRIPT legalized by Principal.Fotokopi NEM/STL/STK/SKHUN/TRANSKRIP Nilai dilegalisasi oleh Kepala Sekolah.
A copy of Birth CerficateFotokopi Akte Kelahiran.
A copy of valid ID/Driving License/PassportFotokopi KTP/SIM/Paspor yang masih berlaku.
Receipt of payment legalized by UPH Finance DepartmentBuk pelunasan pembayaran SPP/BPP/SKS yang telah divalidasi oleh Biro Keuangan UPH.
A complete FORM 021 that has been signed by prospecve student and parent/guardian.FORM 021 yang telah diisi lengkap dan ditandatangani oleh Mahasiswa dan Orangtua/Wali
A recent photos 3x4 using collared shirt with a blue background.
Write name and major on the back of the photo.
Pasfoto ukuran 3x4 menggunakan kemeja berkerah dengan berlatar belakang biru.
Tuliskan nama dan Jurusan Mahasiswa di bagian belakang foto.
To be Submied| Harus DilengkapiCheck| Periksa # Jumlah
ADDITIONAL REQUIREMENT FOR STUDENT FROM INTERNATIONAL CURRICULUMSYARAT TAMBAHAN BAGI CALON MAHASISWA DENGAN KURIKULUM INTERNASIONAL
A Highschool/Diplomas Equivalent Statement issued by Ministry of Educaon & Culture RISurat Penyetaraan Ijazah/Diploma dari Kementrian Pendidikan dan Kebudayaan Republik Indonesia
1 Piece1 Lembar
To be Submied| Harus DilengkapiCheck Periksa #|Jumlah
ADDITIONAL REQUIREMENT FOR STUDENT FROM FOREIGN COUNTRYSYARAT TAMBAHAN BAGI CALON MAHASISWA WARGA NEGARA ASING
Foreigner Study Permit issued by Ministry of Educaon and Culture RISurat Ijin Belajar Warga Negara Asing yang dikeluarkan oleh Kementrian Pendidikan dan Kebudayaan RI
1 Piece1 Lembar
Living Permit in IndonesiaKartu Ijin Menetap Sementara di Indonesia
1 Piece1 Lembar
To be Submied| Harus DilengkapiCheck Periksa #|Jumlah
Checked By,Diperiksa oleh,
Biro ADAK( _________________________________ )
Re-Registraon Procedure | Prosedur Dafar UlangComplete and submit all the requirements below to the Academic Administraon Bureau of UPH/STPPH at Bd. A 3 rdfl. , before July 18, 2014.
Lengkapi dan serahkan persyaratan di bawah ini ke Biro A dministrasi Akademik UPH/STPPH di Gedung A lt.3 sebelum 18 Juli 2014.
Guntngdisini
7/21/2019 409 Undergraduate Admission Manual 1308141037
14/27
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
ADMISSION TEST REGULATION
23
ADMISSION TEST
Admission Test is applicable for: a. Applicants who fail Direct Admission. b. Applicants of Faculty of Medicine. c. Faculty of Educaon (FIP) Teachers College. For further informaon, please call 021.546057 xt.2613 or email [email protected]
UJIAN SARINGAN MASUK
Ujian Saringan Masuk (USM) adalah berlaku bagi:
a. Calon Mahasiswa yang dak lulus Direct Admission. b. Calon Mahasiswa Fakultas Kedokteran.
c. Calon Mahasiswa FIP Teachers College. Untuk Informasi dan Pendaaran mohon menghubungi 021.546057 xt.2613 atau [email protected]
BEFORE THE TEST
a. Parcipants are required to wear their proper are and shoes.b. Parcipants are required to bring own staonery (pens, 2B pencils, erasers, and calculators), Admission Test Parcipant Card and
original ID card (KTP, driving license or other idenficaon which contains photographs of parcipants). Parcipants who do not bringthe equipment, must request permission / memo from the Commiee, aer reporng to the Supervisor.
c. Parcipants must enter the test room 30 minutes before the test starts and sit on the assigned chair. Parcipants who come > 30minutes late are not allowed to take the test and should report to the Commiee.
SEBELUM UJIAN BERLANGSUNG
a. Peserta ujian wajib berpakaian rapi, sopan, dan bersepatu tertutup.
b. Peserta ujian wajib membawa alat tulis (Bolpen, pensil 2B, karet penghapus, dan kalkulator) milik sendiri dan Kartu Tanda Peserta Ujian
Saringan Masuk dan kartu identas asli (KTP, SIM atau identas lainnya yang memuat pasfoto peserta). Peserta yang dak membawaperlengkapan tersebut, wajib meminta izin/memo mengiku ke POSKO setelah melapor ke Pengawas
c. Masuk ke ruang ujian 30 menit sebelum ujian dimulai dan duduk di kursi sesuai dengan No.Peserta. Peserta yang terlambat < 30 menitdiperkenankan mengiku ujian dan me lapor ke Pengawas; dan bagi peserta yang terlambat > 30 menit dak diperkenankan mengikuujian serta harus melapor ke POSKO.
DURING THE TEST
a. Parcipants are prohibited to talk or do anything with the other parcipants, borrow something from the other parcipants and leavethe test room (require permit from the supervisor).
b. Parcipants are not allowed to leave the test room at any me before the supervisor asks you to do so. When the test me has finished,parcipants are required to stop all of the works.
c. Parcipants must write down the answer on the given answer sheet as provided at the test.d. Parents are prohibited to enter and bring parcipants into the test room.e. Breaking the Test Regulaons will cause parcipants a disqualificaon from the test and cancellaon on the registraon process.
SELAMA UJIAN BERLANGSUNG
a. Peserta dilarang berbicara atau melakukan sesuatu dengan peserta lain, pinjam-meminjam sesuatu dengan peserta ujian dan mening-
galkan tempat ujian (harus izin dari pengawas).b. Peserta yang telah menyelesaikan ujian sebelum habis waktu, dilarang meninggalkan tempat ujian. Jika waktu ujian telah habis, peserta
harus menghenkan pekerjaannya setelah ada isyarat/pemberitahuan dari pengawas ujian.c. Ujian hanya sah bila ditulis di atas kertas yang disediakan pada saat ujian.
d. Orang tua dak diperbolehkan mengantar peserta ke ruangan ujian.e. Peserta akan dianggap gugur jika melanggar tata terb Ujian Saringan Masuk, dan dibatalkan proses pendaarannya.
IMPORTANT
Parcipants must not cheat during the USM. If UPH finds out later that there is a cheang in the USM, then parcipants will be terminatedfrom UPH and no fees should be refunded.
Apabila di kemudian hari diketahui bahwa mahasiswa akf telah melakukan kecurangan saat melakukan USM, mahasiswa tersebut akandikeluarkan dari UPH tanpa ada pengembalian biaya kuliah yang telah dibayarkan.
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
NEW STUDENT DATA FORM
22
PARENT/GUARDIANS FULL NAME & SIGNATURETanda tangan dan Nama Lengkap Orangtua/Wali
PROSPECTIVE STUDENTS SIGNATURE & FULL NAMETanda tangan dan Nama Lengkap Calon Mahasiswa
Place Tempat Date
,
Tanggal
Fill in with Capital LeerIsi dengan huruf cetak
FORM
021Form Number / NIM :Nomor Formulir / NIM
Major :Jurusan
No.
01
01
02
03
04
05
06
07
08
09
Full Name *) Nama Lengkap *)
Date of Birth *) Tempat/Tanggal lahir *)
Sex Jenis Kelamin (___) Male Laki Laki (___) Female Perempuan
(___) Married Menikah (___) Unmarried belum MenikahCivilian Status Status Sipil
Religion Agama
Naonality Kewarganegaraan
Phone & Mobile Phone No. Telp dan HP
E-Mail address Alamat Email
ID Card or Driving License Number No.KTP / No.SIM
High School Asal Sekolah
Full Name *) Nama Lengkap *)
Religion Agama
Naonality Kewarganegaraan
Phone & Mobile Phone No. Telp dan HP
Recent Educaon Pendidikan Terakhir
Occupaon Pekerjaan
E-Mail address Alamat Email(Penng untuk Laporan Nilai Ujian per Semester)
Full address (Include Residence & Zip Code)Alamat Lengkap (Perumahan, RT/RW & Kode Pos)
Company, Address & Phone NumberNama Perusahaan, Alamat & No.Telp
02
03
04
05
06
08
09
10
11
Details Keterangan Students Data Data Mahasiswa/i
No. Details Keterangan Fathers Data Data Ayah
Full address (Include Residence & Zip Code)Alamat Lengkap (Perumahan, RT/RW & Kode Pos)
07
01
02
03
04
05
06
07
08
09
Full Name *) Nama Lengkap *)
Religion Agama
Naonality Kewarganegaraan
Phone & Mobile Phone No. Telp dan HP
Recent Educaon Pendidikan Terakhir
Occupaon Pekerjaan
E-Mail address Alamat Email(Penng untuk Laporan Nilai Ujian per Semester)
Full address (Include Residence & Zip Code)Alamat Lengkap (Perumahan, RT/RW & Kode Pos)
Company, Address & Phone NumberNama Perusahaan, Alamat & No.Telp
No. Details Keterangan
I affirm the above
informaon is true.Saya tegaskan informasi di
atas adalah benar.
Mothers Data Data Ibu
Guntngdisini
7/21/2019 409 Undergraduate Admission Manual 1308141037
15/27
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
ADMISSION FORM GUIDELINES
25
PAGE 4
K-33 Form Number
K-34 Major Chosen
See Table 2
K-35 Entry Opon
K-36 Scholarship
K-37 High School Code
See Tabel 7.
If it is not found, leave the column blank.
K-38 High School Locaon
See Table 5 for the Country Code.
If it is not found in the table, please write 99.
See Table 4 for the Province Code and City Code.
If it is not found in the table, please write 00.
K-39 High School Major
See Table 3 for the High School Major Code.
If it is not found in the table, please write 000.
K-40 UPH Campus Locaon
See Table 1
K-41 Junior High School Final Examinaon Score
K-42 Score in Schools Report Grade 10 Semester 1
Fill in this column with your score in Schools Report
Grade 10 Semester 1 for Mathemacs, English,
Chemistry/ Economic, Biology/ Geography and Physics/
Sociology. For example: Your Mathemacs score is 75
then your score should be wrien as follows: 75, 00.
K-43 Score in Schools Report Grade 10 Semester 2
Fill in this column with your score in Schools Report
Grade 10 Semester 2. See K-42
K-44 Score in Schools Report Grade 11 Semester 1
Fill in this column with your score in Schools Report
Grade 11 Semester 1. See K-42
K-45 Score in Schools Report Grade 11 Semester 2
Fill in this column with your score in Schools Report
Grade 11 Semester 2. See K-42
K-46 Siblings
Fill in the column with the month & year of birth of your
siblings.
HALAMAN 4
K-33 No. Formulir
K-34 Kode Pilihan Jurusan
Lihat Tabel 2
K-35 Jalur Masuk
K-36 Beasiswa
K-37 Kode SMA
Lihat Tabel 7.
Bila dak terdapat pada tabel,kosongkan kolom.
K-38 Lokasi SMA
Lihat Tabel 5 untuk kode Negara.
Bila dak terdapat pada tabel, isi dengan 99.
Lihat Tabel 4 untuk kode Propinsi dan kode Kota.
Bila dak terdapat pada tabel, isilah dengan 00.
K-39 Jurusan SMA
Lihat Tabel 3 untuk Kode Jurusan SMA.
Bila dak terdapat pada tabel, isi dengan 000.
K-40 Lokasi Kampus UPH
Lihat Tabel 1
K-41 Nilai UAN SMP
K-42 Nilai Rapor Kelas 10 Semester 1
Isilah kolom dengan nilai rapor kelas 10 Semester 1,
untuk bidang studi Matemaka, Bahasa Inggris,
Kimia/Ekonomi, Biologi/Geografi, Fisika/Sosiologi.
Contoh: Nilai Matemaka Anda 75 maka ditulis 75,00.
K-43 Nilai Rapor Kelas 10 Semester 2
Isilah kolom dengan nilai rapor kelas 10 Semester 2.
Lihat contoh K-42.
K-44 Nilai Rapor Kelas 11 Semester 1
Isilah kolom dengan nilai rapor kelas 11 Semester 1.
Lihat contoh K-42.
K-45 Nilai Rapor Kelas 11 Semester 2
Isilah kolom dengan nilai rapor kelas 11 Semester 2.
Lihat contoh K-42.
K-46 Data Saudara Kandung
Isilah kolom ini dengan data bulan dan tahun lahir
saudara kandung Anda.
Global Perspecve. Global Campus.
UNIVERSITAS PELITA HARAPAN
ADMISSION FORM GUIDELINES
24
PAGE 1
K-01 Form Number
K-02 Students Name
K-03 Place and Date Of Birth
See Table 5 for the Country Code.
If its not found in the table, please write 99.
See Table 4 for the Province Code and City Code.
If it is not found in the table, please write 00.
Example: Born in Jakarta Selatan on September 16, 1995,
then it should be wrien 00 01 01 160995.
K-04 Students Address
K-05 RT & RW
K-06 Province & City
See Table 4. If it is not found in the table, please write 00.
K-07 Country
See Table 5. If it is not found in the table, please write 99.
K-08 Zipcode
PAGE 2
K-09 Form Number
K-10 Parents Name
K-11 Parents Salary
K-12 Parents Religion
K-13 Parents Address
K-14 RT & RW
K-15 Province & City
See Table 4. If it is not found in the table, please write 00.
K-16 Country
See Table 5. If it is not found in the table, please write 99.
K-17 Zipcode
PAGE 3
K-18 Form Number
K-19 Gender
K-20 Marital Status
K-21 Religion
K-22 Cizenship
K-23 Blood Type
K-24 Rhesus Factor
K-25 Phone NumberK-26 Mobile Phone Number
K-27 EAT Cerficate Number
K-28 Students E-Mail Address
K-29 Parents Educaon
K-30 Parents Occupaon
K-31 Parents Handphone
K-32 Parents E-Mail Address
HALAMAN 1
K-01 No. Formulir
K-02 Nama Calon Mahasiswa
K-03 Tempat Dan Tanggal Kelahiran
Lihat Tabel 5 untuk kode Negara.
Bila dak terdapat pada tabel, isi dengan 99.
Lihat Tabel 4 untuk kode Propinsi dan kode Kota.
Bila dak terdapat pada tabel, isi dengan 00.
Contoh: Lahir di Jakarta Selatan, 16 Sept 1995 maka ditulis
000101 160995.
K-04 Alamat Calon Mahasiswa
K-05 RT & RW
K-06 Provinsi & Kota
Lihat Tabel 4. Bila dak terdapat pada tabel, isi dengan 00.
K-07 Negara
Lihat Tabel 5.Bila dak terdapat pada tabel, isi dengan 99.
K-08 Kode Pos
HALAMAN 2
K-09 No. Formulir
K-10 Nama Orang Tua
K-11 Penghasilan Orang Tua
K-12 Agama Orang Tua
K-13 Alamat Orang Tua
K-14 RT & RW
K-15 Provinsi & Kota
Lihat Tabel 4. Bila dak terdapat pada tabel, isi dengan 00.
K-16 Negara
Lihat Tabel 5. Bila dak terdapat pada tabel, isi dengan 99.
K-17 Kode Pos
HALAMAN 3
K-18 No. Formulir
K-19 Jenis Kelamin
K-20 Status Sipil
K-21 Agama
K-22 Kewarganegaraan
K-23 Golongan Darah
K-24 Rhesus
K-25 No. Telepon RumahK-26 No. HP
K-27 Nomor Serfikat EAT
K-28 E-Mail Mahasiswa
K-29 Pendidikan Orang Tua
K-30 Pekerjaan Orang Tua
K-31 No. HP Orang Tua
K-32 E-Mail Orang Tua
7/21/2019 409 Undergraduate Admission Manual 1308141037
16/27
Global Perspectve. Global Campus.
UNIVERSITAS PELITA HARAPAN
TABLE
TABLE 1CAMPUS LOCATION CODE
KODE LOKASI KAMPUS
CODE CAMPUS LOCATION/LOKASI KAMPUS
01 Universitas Pel ita Harapan - Lippo Vil lage
02 Uni vers it as Pe li ta Harapan - Surabaya
012 Accounng 081 Informaon System 023 Visual Communicaon Design
112 Applied Mathemacs 024 Interior Design 803 UPH - RMIT Accounng
022 Architecture 043 Internaonal Relaons 804 UPH - RMIT Communicaon
113 Biotechnology 051 Law 801 UPH - RMIT Management
021 Civil Engineering 011 Management 802 UPH - RMIT Markeng
041 Communicaons 071 Medicine
083 Computer System 061 Music
032 Electrical E ngineering 501 Nursing
034 Food Technology 502 Nursing (Conversion)
541 Hospitality Management 025 Product Design
033 Industrial Engineering 121 Psychology
082 Informacs 542 Travel Industry Management
CODEKODE
MAJOR CODEKODE JURUSAN
CODEKODE
MAJOR CODEKODE JURUSAN
CODEKODE
MAJOR CODEKODE JURUSAN
TABLE 2
MAJOR CODE
KODE JURUSAN
TABLE 3HIGH SCHOOL MAJOR CODE
KODE JURUSAN SMA
CODEKODE
HIGH SCHOOL MAJORKODE JURUSAN SMA
CODEKODE
HIGH SCHOOL MAJORKODE JURUSAN SMA
NATIONAL INTERNATIONAL CURRICULA
011 Ilmu Pengetahuan Alam / Science 051 Internaonal Baccalaureate
012 Ilmu Pengetahuan Sosial / Social 052 Cambridge A Level
019 Lain-lain / Others 053 Cambridge AS Level
059 Others
26
TABLE 4PROVINCE CODE & DISTRICT/ADMINISTRATIVE CITY/REGION CODE
KODE PROPINSI & KODE KOTAMADYA/KOTA ADMINISTRATIF/KABUPATEN
PROVINCE &
CITY/DISTRICTCODE
PROVINCE &
CITY/DISTRICTCODE
PROVINCE &
CITY/DISTRICTCODE
BALI
KOTIP DENPASAR 22 21
KAB. BADUNG 22 31
KAB. BANGLI 22 32
KAB. BULELENG 22 33
KAB. GIANYAR 22 34
KAB. JEMBRANA 22 35
KAB. KARANG ASEM 22 36
KAB. KLUNGKUNG 22 37
KAB. TABANAN 22 38
BANGKA BELITUNG
KODYA PANGKAL PINANG 30 01
KAB. BANGKA 30 31
KAB. BELITUNG 30 32
KAB. BANGKA BARAT 30 33
KAB. BANGKA TENGAH 30 34
KAB. BANGKA SELATAN 30 35
KAB. BELITUNG TIMUR 30 36
BANTEN
KAB. TANGERANG 28 01
KAB.SERANG 28 02
KAB. PANDEGLANG 28 33
KAB. LEBAK 28 34
KOTA CILEGON 28 22
KOTA TANGERANG 28 21
KOTA SERANG 28 23
BENGKULU
KDY. BENGKULU 26 01
KAB. BENGKULU SELATAN 26 31
KAB. BENGKULU UTARA 26 32
KAB. REJANG LEBONG 26 33
KAB. KAUR 26 34
KAB. KEPAHIANG 26 35
KAB. LEBONG 26 36
KAB. MUKO-MUKO 26 37
KAB. SELUMA 26 38
KAB. BENGKULU TENGAH 26 39
D.I YOGYAKARTA
KDY. YOGYAKARTA 04 01
KAB. KULON PROGO 04 31
KAB. BANTUL 04 32
KAB. GUNUNG KIDUL 04 33
KAB. SLEMAN 04 34
DKI JAKARTA
KDY. JAKARTA 01 00
KDY. JAKARTA SELATAN 01 01
KDY. JAKARTA TIMUR 01 02
KDY. JAKARTA PUSAT 01 03
KDY. JAKARTA BARAT 01 04
KDY. JAKARTA UTARA 01 05
KAB. KEPULAUAN SERIBU 01 06
GORONTALO
KODYA GORONTALO 32 01
KAB. GORONTALO 32 31
KAB. BOALEMO 32 32
KAB. BONE BOLANGO 32 33
KAB. PAHUWATO 32 34
KAB. GORONTALO UTARA 32 35
JAMBI
KDY. JAMBI 10 01
KAB. JAMBI 10 31
KAB. MUARA BUNGO TEBO 10 32
KAB. TANJUNG JABUNG 10 33
KAB. BATANG HARI 10 34
KAB. BANGKO SARULANGUN 10 35
KAB. KERINCI 10 36
KAB. SARKO 10 37
KAB. BUNGO 10 38
KAB. MERANGIN 10 39
KAB. MUARO JAMBI 10 40
KAB. SAROLANGUN 10 41
KAB. TANJUNG JABUNG BARAT 10 42
KAB. TANJUNG JABUNG TIMUR 10 43
KAB. TEBO 10 44
KDY. SUNGAI PENUH 10 45
JAWA BARAT
KDY. BANDUNG 02 01
KDY. BOGOR 02 02
KDY. SUKABUMI 02 03
KDY. CIREBON 02 04
KOTIP TANGERANG 02 21
KOTA TASIKMALAYA 02 22
KOTA BEKASI 02 23
KOTA DEPOK 02 24
KOTA CIMAHI 02 25
KAB. PADEGELANG 02 31
KAB. LEBAK 02 32
KAB. BOGOR 02 33
KAB. SUKABUMI 02 34
KAB. CIANJUR 02 35
KAB. BANDUNG 02 36
KAB. GARUT 02 37
KAB. TASIK MALAYA 02 38
KAB. CIAMIS 02 39
KAB. KUNINGAN 02 40
KAB. CIREBON 02 41
KAB. MAJALENGKA 02 42
KAB. SUMEDANG 02 43
KAB. INDARAMAYU 02 44
KAB. SUBANG 02 45
KAB. PURWAKARTA 02 46
KAB. KARAWANG 02 47
KAB. TANGERANG 02 48
KAB. SERANG 02 49
KAB. BEKASI 02 50
KAB. SUBANG 02 52
KOTA BANJAR 02 05
KAB. BANDUNG BARAT 02 53
JAWA TENGAH
KDY. MAGELANG 03 01
KDY. SURAKARTA 03 02
KDY. SALATIGA 03 03
KDY. SEMARANG 03 04
KDY. PEKALONGAN 03 05
KDY. TEGAL 03 06
KOTIP PURWOKERTO 03 21
KOTIP CILACAP 03 22
KAB. CILACAP 03 31
KAB. BANYUMAS 03 32
KAB. PURBALINGGA 03 33
KAB. BANJARNEGARA 03 34
KAB. KEBUMEN 03 35
KAB. PURWOREJO 03 36
KAB. WONOSOBO 03 37
KAB. MAGELANG 03 38
KAB. BOYOLALI 03 39
KAB. KLATEN 03 40
KAB. SUKOHARJO 03 41
KAB. WONOGIRI 03 42
KAB. KARANG ANYAR 03 43
KAB. SRAGEN 03 44
KAB. GROBOGAN 03 45
KAB. BLORA 03 46
KAB. REMBANG 03 47
KAB. PATI 03 48
KAB. KUDUS 03 49
KAB. JEPARA 03 50
KAB. DEMAK 03 51
KAB. SEMARANG 03 52
KAB. TEMANGGUNG 03 53
KAB. KENDAL 03 54
KAB. BATANG 03 55
KAB. PEKALONGAN 03 56
KAB. PEMALANG 03 57
KAB. TEGAL 03 58
KAB. BREBES 03 59
27
7/21/2019 409 Undergraduate Admission Manual 1308141037
17/27
CONTINUED (LANJUTAN)PROVINCE CODE & DISTRICT/ADMINISTRATIVE CITY/REGION CODE
KODE PROPINSI & KODE KOTAMADYA/KOTA ADMINISTRATIF/KABUPATEN
PROVINCE &
CITY/DISTRICTCODE
PROVINCE &
CITY/DISTRICTCODE
PROVINCE &
CITY/DISTRICTCODE
JAWA TIMUR
KDY. SURABAYA 05 01
KDY. MOJOKERTO 05 02
KDY. MALANG 05 03
KDY. PASURUHAN 05 04
KDY. KEDIRI 05 05
KDY. BLITAR 05 06
KDY. PROBOLINGGO 05 07
KDY. MADIUN 05 08
KOTIP JEMBER 05 21
KAB. PACITAN 05 31
KAB. PONOROGO 05 32
KAB. TRENGGALEK 05 33
KAB. TULUNG AGUNG 05 34
KAB. BLITAR 05 35
KAB. KEDIRI 05 36
KAB. MALANG 05 37
KAB. LUMAJANG 05 38
KAB. JEMBER 05 39
KAB. BANYUWANGI 05 40
KAB. BONDOWOSO 05 41
KAB. PANARUKAN 05 42
KAB. PROBOLINGGO 05 43
KAB. PASURUHAN 05 44
KAB. SIDOARJO 05 45
KAB. MOJOKERTO 05 46
KAB. JOMBANG 05 47
KAB. NGANJUK 05 48
KAB. MADIUN 05 49
KAB. MAGETAN 05 50
KAB. NGAWI 05 51
KAB. BOJONEGORO 05 52
KAB. TUBAN 05 53
KAB. LAMONGAN 05 54
KAB. GRESIK 05 55
KAB. BANGKALAN 05 56
KAB. SAMPANG 05 57
KAB. PAMEKASAN 05 58
KAB. SUMENEP 05 59
KOTA BATU 05 22
KAB. SITUBONDO 05 60
KAB. PAMEKASAN 05 61
KALIMANTAN BARAT
KDY. PONTIANAK 13 01
KOTA SINGKAWANG 13 21
KAB. PONTIANAK 13 31
KAB. SAMBAS 13 32
KAB. SANGGAU 13 33
KAB. KETAPANG 13 34
KAB. SINTANG 13 35
KAB. KAPUAS HULU 13 36
KAB. BENGKAYANG 13 37
KAB. LANDAK 13 38
KAB. MELAWI 13 39
KAB. SEKADAU 13 40
KAB. KAYONG UTARA 13 41
KAB. KUBU RAYA 13 42
KALIMANTAN SELATAN
KDY. BANJARMASIN 15 01
KOTIP PEKANBARU 15 21
KAB. TANAH LAUT 15 31
KAB. KOTA BARU 15 32
KAB. BANJAR 15 33
KAB. BARITOKUALA 15 34
KAB. TAPIN 15 35
KAB. HULU SUNGAI SELATAN 15 36
KAB. HULU SUNGAI TENGAH 15 37
KAB. HULU SUNGAI UTARA 15 38
KAB. TABALONG 15 39
KAB. BALANGAN 15 40
KAB. TANAH BUMBU 15 41
KOTA BANJAR BARU 15 22
KALIMANTAN TENGAH
KDY. PALANGKA RAYA 14 01
KAB. KOTA WARINGIN BARAT 14 31
KAB. KOTA WARINGIN TIMUR 14 32
KAB. KATINGAN 14 33
KAB. KAPUAS 14 34
KAB. BARITO SELATAN 14 35
KAB. BARITO TIMUR 14 36
KAB. BARITO UTARA 14 37
KAB. GUNUNG MAS 14 38
KAB. MURUNG RAYA 14 39
KAB. SERUYAN 14 40
KAB. LAMANDAU 14 41
KAB. PULANG PISAU 14 42
KAB. SUKAMARA 14 43
KALIMANTAN TIMUR
KDY. SAMARINDA 16 01
KDY. BALIKPAPAN 16 02
KOTIP TARAKAN 16 21
KAB. BERAU 16 31
KAB. BULUNGAN 16 32
KAB. KUTAI 16 33
KAB. PASER 16 34
KAB. NUNUKAN 16 39
KAB. PENAJAM PASER UTARA 16 40
KOTA BONTANG 16 41
KAB. KUTAI KARTANEGARA 16 42
KAB. MALINAU 16 43
KAB. KUTAI BARAT 16 44
KAB. KUTAI TIMUR 16 45
KAB. TANA TIDUNG 16 46
KEPULAUAN RIAU
KDY. BATAM 36 01
KDY. TANJUNG PINANG 36 02
KAB. BINTAN 36 31
KAB. KARIMUN 36 32
KAB. NATUNA 36 33
KAB. LINGGA 36 34
KAB. KEPULAUAN ANAMBAS 36 35
LAMPUNG
KDY. TANJUNG KARANG 12 01
KDY. BANDAR LAMPUNG 12 02
KAB. LAMPUNG SELATAN 12 31
KAB. LAMPUNG TENGAH 12 32
KAB. LAMPUNG UTARA 12 33
KAB. LAMPUNG BARAT 12 34
KAB. LAMPUNG TIMUR 12 35
KAB. TENGGAMUS 12 39
KAB. TULANG BAWANG 12 40
KAB. WAY KANAN 12 41
KOTA METRO 12 21
KAB. PESAWARAN 12 42
MALUKU
KDY. AMBON 21 01
KOTIP TERNATE 21 21
KAB. MALUKU TENGGARA 21 31
KAB. MALUKU TENGAH 21 32
KAB. HALMARERA TENGAH 21 33
KAB. MALUKU UTARA 21 34
KAB. KEPULAUAN ARU 21 35
KAB. BURU 21 36
KAB. MALUKU TENGGARA BARAT 21 37
KAB. SERAM BAGIAN BARAT 21 38
KAB. SERAM BAGIAN TIMUR 21 39
KOTA TUAL 21 02
KAB. MALUKU BARAT DAYA 21 40
KAB. BURU SELATAN 21 41
MALUKU UTARA
KAB. HALMAHERA TENGAH 33 32
KAB. MALUKU UTARA 33 31
KAB. HALMAHERA BARAT 33 33
KAB. HALMAHERA SELATAN 33 34
KAB. HALMAHERA TIMUR 33 35
KAB. HALMAHERA UTARA 33 36
KAB. KEPULAUAN SULA 33 37
KOTA TERNATE 33 21
KOTA TIDORE KEPULAUAN 33 22
28
CONTINUED (LANJUTAN)PROVINCE CODE & DISTRICT/ADMINISTRATIVE CITY/REGION CODE
KODE PROPINSI & KODE KOTAMADYA/KOTA ADMINISTRATIF/KABUPATEN
PROVINCE &
CITY/DISTRICTCODE
PROVINCE &
CITY/DISTRICTCODE
PROVINCE &
CITY/DISTRICTCODE
NAD
KDY. BANDA ACEH 06 01
KDY. SABANG 06 02
KAB. ACEH SELATAN 06 31
KAB. ACEH TENGGARA 06 32
KAB. ACEH TIMUR 06 33
KAB. ACEH TENGAH 06 34
KAB. ACEH BARAT 06 35
KAB. ACEH BESAR 06 36
KAB. ACEH UTARA 06 37
KAB. PIDIE 06 38
KAB. ACEH BARAT DAYA 06 39
KAB. ACEH JAYA 06 40
KAB. ACEH SINGKIL 06 41
KAB. ACEH TAMIANG 06 42
KAB. BENER MERAH 06 43
KAB. BIREUEN 06 44
KAB. GAYO LUES 06 45
KAB. NAGAN RAYA 06 46
KAB. SIMAULUE 06 47
KOTA LANGSA 06 48
KOTA LHOKSEUMAWE 06 49
KAB. PIDIE JAYA 06 50
KDY. SUBULUSSALAM 06 51
NUSA TENGGARA BARAT
KOTIP MATARAM 23 21
KAB. BIMA 23 31
KAB. DOMPU 23 32
KAB. LOMBOK TENGAH 23 34
KAB. LOMBOK TIMUR 23 35
KAB. SUMBAWA 23 36
KAB. SUMBAWA BARAT 23 37
KOTA BIMA 23 22
KAB. LOMBOK BARAT 23 38
KAB. LOMBOK UTARA 23 39
NUSA TENGGARA TIMUR
KOTA KUPANG 24 21
KAB. SUMBA BARAT 24 31
KAB. SUMBA TIMUR 24 32
KAB. TIMOR TENGAH SELATAN 24 33
KAB. TIMOR TENGAH UTARA 24 34
KAB. BELU 24 35
KAB. ALOR 24 36
KAB. FLORES TIMUR 24 37
KAB. SIKKA 24 38
KAB. ENDE 24 39
KAB. NGADE 24 40
KAB. MANGGARAI 24 41
KAB. KUPANG 24 42
KAB. LEMBATA 24 43
KAB. MANGGARAI BARAT 24 44
KAB. ROTE NDAO 24 45
KAB. NAGEKEO 24 46
KAB. SUMBA TENGAH 24 47
KAB. SUMBA BARAT DAYA 24 48
KAB. MANGGARAI TIMUR 24 49
PAPUA
KOTA JAYAPURA 25 21
KAB. FAK-FAK 25 31
KAB. JAYAPURA 25 32
KAB. MANOKWARI 25 33
KAB. MERAUKE 25 34
KAB. PANIAI/NABIRE 25 35
KAB. SORONG 25 36
KAB. TELUK CENDRAWASIH 25 37
KAB. KEPULAUAN YAPEN 25 38
KAB. PUNCAK JAYA 25 39
KAB. ASMAT 25 40
KAB. BIAK NUMFOR 25 41
KAB. BOVEL DIGOEL 25 42
KAB. JAYAWIJAYA 25 43
KAB. KEEROM 25 44
KAB. MAPPI 25 45
KAB. MIMIKA 25 46
KAB. NABIRE 25 47
KAB. PEGUNUNGAN BINTANG 25 48
KAB. SARMI 25 49
KAB. SUPRIORI 25 50
KAB. TOLIKARA 25 51
KAB. WAROPEN 25 52
KAB. YAHUKIMO 25 53
KAB. MAMBERAMO RAYA 25 54
KAB. MAMBERAMO TENGAH 25 55
KAB. YALIMO 25 56
KAB. LANNY JAYA 25 57
KAB. NDUGA 25 58
KAB. PUNCAK 25 59
KAB. DOGIYAI 25 60
PAPUA BARAT
KAB. FAK-FAK 34 33
KAB. MANOKWARI 34 34
KAB. SORONG 34 31
KAB. KAIMANA 34 35
KAB. RAJA AMPAT 34 36
KAB. SORONG SELATAN 34 32
KOTA SORONG 34 21
KAB. TELUK BINTUNI 34 37
KAB. TELUK WONDAMA 34 38
RIAU
KDY. PEKAN BARU 09 01
KDY. BATAM 09 02
KOTIP DUMAI 09 21
KAB. INDRAGIRI HULU 09 31
KAB. INDRAGIRI HILIR 09 32
KAB. KEPULAUAN RIAU 09 33
KAB. KAMPAR 09 34
KAB. BENGKALIS 09 35
KAB. KARIMUN 09 41
KAB. NATUNA 09 42
KAB. LINGGA 09 43
KOTA TANJUNG PINANG 09 22
KAB. PELALAWAN 09 44
KAB. ROKAN HULU 09 45
KAB. ROKAN HILIR 09 46
KAB. SIAK 09 47
KAB. KUANTAN SINGINGI 09 48
SULAWESI BARAT
KAB. MAJENE 31 31
KAB. MAMUJU 31 32
KAB. MAMASA 31 33
KAB. MAMUJU UTARA 31 39
KAB. POLEWALI MANDAR 31 40
SULAWESI SELATAN
KDY. UJUNG PANDANG 19 01
KDY. PARE PARE 19 02
KAB. SELAYAR 19 31
KAB. BULUKUMBA 19 32
KAB. BANTAENG 19 33
KAB. JENEPONTO 19 34
KAB. TAKALAR 19 35
KAB. GOWA 19 36
KAB. SINJAI 19 37
KAB. BONE 19 38
KAB. MAROS 19 39
KAB. PANGKAJENE KEPULAUAN 19 40
KAB. BARU 19 41
KAB. SOPPENG 19 42
KAB. WAJO 19 43
KAB. SINDERENG RANPPANG 19 44
KAB. PINRANG 19 45
KAB. PAREKANG 19 46
KAB. LUWU 19 47
KAB. TANA TORAJA 19 48
KAB. POLEWALI MAMASA 19 49
KAB. MAJENE 19 50
KAB. MAMUJU 19 51
KAB. ENREKANG 19 52
KAB. LUWU TIMUR 19 53
KAB. LUWU UTARA 19 54
KOTA MAKASAR 19 21
KOTA PALOPO 19 22
KAB. TORAJA UTARA 19 55
29
7/21/2019 409 Undergraduate Admission Manual 1308141037
18/27
CONTINUED (LANJUTAN)PROVINCE CODE & DISTRICT/ADMINISTRATIVE CITY/REGION CODE
KODE PROPINSI & KODE KOTAMADYA/KOTA ADMINISTRATIF/KABUPATEN
PROVINCE &
CITY/DISTRICTCODE
PROVINCE &
CITY/DISTRICTCODE
PROVINCE &
CITY/DISTRICTCODE
SULAWESI TENGAH
KOTA PALU 18 21
KAB. BUAL TOLI TOLI 18 33
KAB. DONGGALA 18 34
KAB. LUWUK/BANGGAI 18 35
KAB. POSO 18 36
KAB.BANGGAI KEPULAUAN 18 37
KAB.BUOL 18 38
KAB.MOROWALI 18 39
KAB.PARIGI MOUTONG 18 40
KAB.TOLI-TOLI 18 41
KAB. TOJO UNA-UNA 18 42
KAB. SIGI 18 43
SULAWESI TENGGARA
KOTA KENDARI 20 21
KOTA BAU BAU 20 22
KAB. KENDARI 20 31
KAB. BUTON 20 32
KAB. KOLAKA 20 33
KAB. MUNA 20 34
KAB. BOMBANA 20 37
KAB. KOLAKA UTARA 20 38
KAB. KONAWE 20 39
KAB. WAKATOBI 20 41
KAB. KONAWE SELATAN 20 40
KAB. KONAWE UTARA 20 42
KAB. BUTON UTARA 20 43
SULAWESI UTARA
KDY. MANADO 17 01
KDY. GORONTALO 17 02
KOTIP BITUNG 17 21
KAB. BOLAANG MONGONDOW 17 31
KAB. MINAHASA 17 32
KAB. SANGIHE TALAUD 17 33
KAB. GORONTALO 17 34
KOTA TOMOHON 17 35
KDY. KOTAMOBAGU 17 03
KAB. BOLAANG MONGONDOW
TIMUR17 44
KAB. BOLAANG MONGONDOW
SELATAN17 36
KAB. KEPULAUAN SANGIHE 17 37
KAB. KEPULAUAN TALAUD 17 38
KAB. MINAHASA SELATAN 17 39
KAB. MINAHASA UTARA 17 40
KAB. MINAHASA TENGGARA 17 41
KAB. BOLAANG MONGONDOW
UTARA17 42
KAB. KEP. SIAU TAGULANDANG BIA 17 43
SUMATERA SELATAN
KDY. PALEMBANG 11 01
KDY. PANGKAL PINANG 11 02
KOTA LUBUK LINGGAU 11 21
KOTIP PRABUMULIH 11 22
KOTIP BATURAJA 11 23
KAB. OGAN KOMERING HULU 11 31
KAB. OGAN KOMERING HILIR 11 32
KAB. MUARA ENIM / LIOT 11 33
KAB. LAHAT 11 34
KAB. MUSI RAWAS 11 35
KAB. MUSI BANYUASIN 11 36
KAB. BANGKA 11 37
KAB. BELITUNG 11 38
KDY. PAGAR ALAM 11 24
KAB. BANYUASIN 11 39
KAB. OGAN ILIR 11 40
KAB. OKU SELATAN 11 41
KAB. OKU TIMUR 11 42
KAB. OGAN KOMERING ULU TIMUR 11 43
KAB. OGAN KOMERING ULU
SELATAN11 44
KAB.EMPAT LAWANG 11 45
SUMATRA BARAT
KDY. PADANG 08 01
KDY. SAWAH LUNTO 08 03
KDY. PADANG PANJANG 08 04
KDY. BUKIT TINGGI 08 05
KDY. PAYAKUMBUH 08 06
KAB. PESISIR SELATAN 08 31
KAB. SOLOK 08 32
KAB. SAWAH LUNTO SIJUNJUNG 08 33
KAB. TANAH DATAR 08 34
KAB. PADANG PARIAMAN 08 35
KAB. AGAM 08 36
KAB. LIMAPULUH KOTA 08 37
KAB. PASAMAN 08 38
KAB. DHARMAS RAYA 08 39
KAB. KEPULAUAN MENTAWAI 08 40
KAB. PASAMAN BARAT 08 41
KAB. SOLOK SELATAN 08 42
KOTA PARIAMAN 08 22
KAB. SIJUNJUNG 08 43
SUMATRA UTARA
KDY. MEDAN 07 01
KDY. SIBOLGA 07 02
KDY. TANJUNG BALAI 07 03
KDY. PEMATANG SIANTAR 07 04
KDY. TEBING TINGGI 07 05
KDY. BINJAI 07 06
KOTIP KISARAN 07 21
KOTIP PADANG SIDEMPUAN 07 22
KAB. NIAS 07 31
KAB. TAPANULI SELATAN 07 32
KAB. TAPANULI TENGAH 07 33
KAB. TAPANULI UTARA 07 34
KAB. LABUHAN BATU 07 35
KAB. ASAHAN 07 36
KAB. SIMALUNGUN 07 37
KAB. DAIRI 07 38
KAB. KARO 07 39
KAB. DELI SERDANG 07 40
KAB. LANGKAT 07 41
KAB. HUMBANG HASUNDUTAN 07 42
KAB. LANGKAT 07 50
KAB. MANDAILING NATAL 07 44
KAB. NIAS SELATAN 07 45
KAB. SAMOSIR 07 47
KAB. SERDANG BEDAGAI 07 48
KAB. TOBA SAMOSIR 07 49
KOTA PADANG SIDEMPUAN 07 51
KAB. LABUHANBATU SELATAN 07 52
KAB. LABUHANBATU UTARA 07 53
KAB. PAKPAK BHARAT 07 54
KAB. BATU BARA 07 55
KAB. PADANG LAWAS UTARA 07 56
KAB. PADANG LAWAS 07 57
TIMOR TIMUR
KOTIP DILI 27 21
KAB. BAUCAU 27 31
KAB. MANATURO 27 32
KAB. LAUTEM 27 33
KAB. VIQUEQUE 27 34
KAB. AINARO 27 35
KAB. MANUFAHI 27 36
KAB. COVA LIMA 27 37
KAB. AMBENO 27 38
KAB. BOBONARO 27 39
KAB. LIQUICA 27 40
KAB. ERMERA 27 41
KAB. AILEU 27 42
30
TABLE 5COUNTRY CODE
KODE NEGARA / BANGSA
ASIA AMERICA OCEANIA
00 Indonesia 48 United States of America 86 Australia
01 Arab, United Emirates 49 Argenna 8 7 C hr is tm as I sl an d
03 Bahrain 50 Alaska 88 Fiji Island
05 Burma 51 Brazil 89 Polynesia
07 Cambodia 52 Canada 91 New Caledonia
06 China 53 Chile 92 New Hebrides
08 Hong Kong 54 Colombia 93 New Zealand
09 India 55 Cuba 99 OTHERS
10 Iran 56 Mexico
13 Japan 57 Panama
14 Jordan 58 Venezuela17 Kuwait EUROPE
18 Laos 60 Austria
19 Lebanon 61 Belgium
20 Macau 62 Bulgaria
21 Malaysia 63 Netherlands
24 Philippines 64 Cyprus
25 Saudi Arabia 65 Czech Republic
27 Singapore 66 Denmark
16 South Korea 67 Hongary
28 Syria 68 Ireland
30 Taiwan 69 Italy
29 Thailand 70 United Kingdom
31 Turki 71 Germany
32 Vietnam 72 Luxembourg
33 Yaman 73 Poland
AFRICA 74 Portugal
36 Algeria 75 France
37 Libya 76 Spain
38 Morocco 77 Sweden
39 Egypt 78 Switzerland
40 Madagascar 79 Soviet Union42 Sudan 80 Greece
43 Tanzania 81 Yugoslavia
44 Tunisia
45 Uganda
CODE COUNTRY NAME CODE COUNTRY NAME CODE COUNTRY NAME
31
7/21/2019 409 Undergraduate Admission Manual 1308141037
19/27
Jenis Nama SMAKode
SMAJenis Nama SMA
Kode
SMAJenis Nama SMA
Kode
SMAJenis Nama SMA
Kode
SMAJenis Nama SMA
Kode
SMAJenis Nama SMA
Kode
SMA
Jenis Nama SMAKode
SMAJenis Nama SMA
Kode
SMAJenis Nama SMA
Kode
SMA
TABLE 6HIGH SCHOOL NAME & CODE
DAFTAR NAMA & KODE SEKOLAH
A. PULAU JAWA
Wilayah Jabodetabek
(Jakarta, Bogor, Depok, Tangerang,
Serpong & Bekasi)
Jenis Nama SMA Kode SMA
SGO Negeri 31712767
SMA 17 Agustus 45, Tebet 31714012
S MA 2 8 O kt ob er 1 92 8, W a ru ng B un ci t 3 17 14 02 7
SMA Adi Luhur, Balekembang 31725952
SMA AlHikmah,PuloGadung 31724366
SMA Al Irsyad, Hasyim Ashari 31734016
SMA AlWashliyah,Ja 31725872
SMA Al-Chasanah, Tanjung Duren 31744011
SMA Alhuda, Cengkareng 31744026
SMA Al-Kamal, Kedoya 31743865
S MA A l- kh ai ri ya h, Ta nj un g P ri ok 3 175 40 13
SMA Al-Kholidin, Melawai 31713855
S MA A l- Mu ha ji r in , R aw a B ad ak S el at an 3 17 53 84 2
SMA Ananda, Bekasi 00320008
SMA Ananda, Bekasi 01310008
S MA A n gk as a 2 , H al im P er da n a Ku s um a 3 17 23 86 1
SMA Angkasa, Halim P k. 31724231
SMA API, Menteng 31734024
SMA ArenaSiswa1,Gunung Sahari 31734032
SMA Arena Siswa 2, Kenari 31734047
SMA Arena Siswa 4, Koja 31754237
SMA Arena Siswa, Bekasi 01310006
SMA Asisi, Menteng Dalam 31714035
SMA As-syaiyah2, Jt.Waringin 31724014
SMA Asysyiyah, Bukit Duri 31714043
SMA AsySyukuriyah,Cipondoh,Tangerang 33320034
SMA AsaDipamkara, Karawaci 33320036
SMA Aaqwa,Gunung SahariUtara 31733843
SMAAustralian InternaonalSchool,
PejatenBarat00220013
SMA Avicenna ,Ja karta Selatan 00220006
SMA Bahagia II ,Kebon Kacang 31734674
SMA Bahariawan45,KelapaGading 31754021
SMA BakPutra,KebayoranLamaSel 31713853
SMA BapsCengkareng,Kapuk 31743831
SMA Barunawa,Slipi 31743866
SMA Bellarminus 2, Bekasi 01310007
SMA Bethel, Jelambar 31754276
SMA Bethel, P etamburan 31733862
SMA BhakIdhata,Cilandak 31714051
SMA BhakMulya, Lebak Bulus 31714656
SMA BhakSamodra, Klender 31723974
SMA Bhayangkari, Ragunan 31714066
S MA B hi nek a Tu ng ga l Ika , Ta mb or a 3 174 40 42
SMA Bhudaya2, DurenSawit 31723859
S MA B in a Ba ng sa P IK , Ja ka rt a Ut ar a 0 062 00 28
SMA Bina Ban gsa, J aka rta Barat 31744974
SMA BinaDarma,Senen 31733887
SMA BinaGama,KebayoranLama 00220004
SMA Bina Insani, Bogor 00820004
SMA Bina Ku suma Pesan ggrahan 31713861
SMA Bina Lestari, Kuningan 31714194
SMA BinaSiswa,PasebanDalam 31733961
SMA Bina Tunas Bangsa 00620015
SMA Binatama, Pisangan Lama 31724022
S MA B in ta ng Ke jo ra , Cen gka ren g 3 174 41 83
SMA Binta ng Mas, Pen jaringan 31754044
S MA B in us H ig h Sc ho ol , S im pr uk 0 022 00 01
SMA BKKK Agape, Tangerang 33320018
SMA BKUI, Kebayoran Baru 31714074
SMA BKUI, Pulo 31713856
SMA Boni Sis wa, Menteng Pulo 31714082
SMA Borobudur, Cilandak 31714461
SMA BPSK 1, Pondok Kopi 31723856
SMA BPSK, Tanah Abang 31734055
SMA Budaya, Salemba 31734063
SMA Budhaya, Matraman 31724037
SMA Budhi Ciswa, Kemayoran 31734071
SMA BudhiWarman2,Kramat Ja 31723893
SMA BudhiWarman, Kramat Ja 31724045
SMA Budi Agung, Bandengan 00620002
SMA Budi Anugerah, Krekot 31734272
SMA Budi Luhur, Tangerang 33320020
SMA Budi Mulia, Bogor 31841003
SMA Budi Mulia, Mang ga Bes ar 31734086
SMA Budi Murni Kedoya 31744057
SMA Budi Murni 1, Pasar R ebo 31724084
SMA Budi Murn i2, Kemba ngan 31743823
S MA B ud i Mu rn i 3, P on do k Ba mb u 3 172 38 53
SMA BudiUtomo,Depok 01420008
SMA Budi Waluyo, Petogogan 31713854
SMA Bukit Sion, Jakarta Barat 00520025
SMA BundaHaKudus, Jelambar 31744065
SMA
BundaHaKudus, KotaWisata
Bogor 00820010
S MA B un da K an du ng , Pa sa r M in gg u 3 17 13 95 6
SMA BundaMulia InternaonalSchoo l 00620023
SMA Bunda Mulia, Petojo 00420011
SMA Bunga Harapan, Barat 31743963
SMA BungaHaBangsa 00620014
SMA Cahaya Kudus, Pluit 31753831
SMA CahayaSak, Janegara 31724111
SMA CakraBuana,Depok 01420003
SMA Cakra Buana, Tegal Alur 31743830
S MA C aw an g Ba ru 1, C aw an g Ba ru 3 172 41 03
SMA Cempaka,CempakaPuhBarat 31733856
S MA C en dr aw as ih II , Po nd ok Ar en 3 332 00 16
SMA Cendrawasih, GandariaSelatan 31714101
SMA C engkareng ,Cengkareng 31744251
S MA C en tr al S ch oo l, J aka rt a Ba ra t 0 052 00 26
S MA C ha nd ra K us um a, K ap uk M ua ra 3 17 53 84 1
SMA ChandraNaya,GajahMada 31744073
SMA Charitas, Lebak Bulus 31714654
SMA Cikra, Rawamangun 31723826
SMA Cindera Mata, Bekasi 01320012
SMA Cipta Karya, Cawang 31724006
S MA C it a Bu an a, Ja ka rt a Sel at an 0 022 00 08
S MA C it ra K as ih , Ci mo ne , Ta ng er an g 3 33 20 02 7
SMA C orpatar in, Po ndok Kopi 31723854
SMA Daar El-Qolam,Balaraja-Tangerang 33320022
SMA DamaiMekar, Bogor 00820007
SMA DamaiMekar, Bogor 00820007
SMA Damai, DuriSelatan 31743851
SMA DarulMarif,Cipete 31714116
SMA Darum Muminin, Janegara 31724304
SMA Darussalam, Pondok Labu 31714573
SMA DewiSarka, Balimester 31723832
SMA DewiSarka, Jauwung 33320033
SMA DewiSarka, Tebet 31713917
SMA Dhammasavana, JembatanDua 31743947
SMA DharmaBhak,Sunter Agung 31753847
SMA DharmaBhak,CempakaPuh 31733872
SMA DharmaBudhiBak,JakartaUtara 00620010
SMA DharmaJaya,Jelambar 31743836
SMA DharmaKaryaUt 33320028
SMA DharmaKarya,KebayoranBaru 31714132
SMA DharmaPutra,Kebon Bawang 31753848
SMA DharmaPutra,Tangerang 33320010
SMA Dharma Satria,Pejagalan 31753840
SMA Dharma Suci, Pejagalan 31753837
SMA DianH arapan, Cikarang 01320001
SMA DianHarapan, DaanMogot,Jak Bar 00520017
SMA DianH arapan, Tangerang 31840008
SMA DianKasih,JakartaBarat 00520012
SMA DianKasih,Tangerang 33320032
SMA DianPersada, Cipinang Timur 31723823
SMA Diponegoro2,Cakung 31723862
SMA Diponegoro,Rawamangun 31726036
SMA Don Bosco1, Pegangsaan Dua 31753857
SMA Don Bosco2, PuloMas 31724416
SMA Don BoscoSeruni, Pondok Indah 31714655
SMA Don Bosco,ManggaBesar 31734113
SMA DwiDaya2,KebayoranLama 31713867
SMA DwiPutra ,Ciputat-Jakarta Selatan 00220009
SMA DwiWarna, Bogor 00820002
SMA DwiWarna, Bogor 00820002
SMA Dwisaka,Pegan 31733863
SMA DwisayaI, KebayoranBaru 31714147
SMA EkaSak, Cengkareng Timur 31743833
SMA EkaSak, Tanjung Duren 31744096
SMA Eka Wijaya, Bogor 00820014
32
SMAElShaddaiInternaonalSchool,
JakartaBarat0520028
S MA E l-S yi fa , Ka mp un g Se tu C ig a 3 17 13 86 4
S MA F aj ar I nd ah , Pa de ma ng an B ar at 3 17 53 85 9
SMA FajrulIslam, KaliDeres 31743828
SMA Fatahillah, Grogol 31744107
SMA Fatahillah, Kali bata 31713866
SMA Fons Vitae 1, Matraman 31724061
S MA Fo ns V it ae 2, Ta nj un g P ri ok 3 17 53 86 1
S MA F on s V it ae 3 / M a rs ud ir in i, B ek as i 3 18 42 00 3
SMA Fransiskus 2, Kp. Ambon 31724076
SMA Fransiskus, Kramat 31734136
SMA GajahMada,CempakaPuhBarat 31733857
SMA Galaa1, WijayaKusuma 31743843
SMA Galaa3, Pegadungan 31743826
SMA Galaa,Bekasi 03520003
SMA Gamaliel, JakartaUtara 00620008
SMA GandhiInternasional School, Ancol 00620007
SMAGandhiMemorial Internaonal
School, Kemayoran31733848
SMA GandhiSchool, Kemayoran 31733844
SMA GandhiSchool, PangandaranA ncol 31753886
SMA GhandiPoera, Cijantung 31724343
SMA Giki2, JakartaUtara 31753926
SMA GitaKir2,Sunter Jaya 31753850
SMA GiaKir 3, GandariaUtara 31713858
SMA GlobalIslamic School, Condet 00320002
SMA GlobalJaya, Tangerang 33320019
SMA GlobalPrestasi, Kalimalang,Bekasi 01320013
SMA GMK,Karet 31714155
SMA Gonzaga,Pasar Minggu 31714631
SMA Guntur,Pejompongan 31734167
SMA HamastoInstut,Cidodol 31713972
SMA Hang Tuah 1, Cipulir 31713852
S MA H ar ap an 1 , Pr am uk a Mu rt ad o 3 17 34 17 5
S MA H ar ap an 2 , Pr am uk a Mu rt ad o 3 17 33 92 2
SMA Harapan Abadi, Pluit 31753835
S MA H ar ap an B an gs a, Ta nge ra ng 3 33 20 00 4
S MA H ar ap an I bu , Po nd ok P in an g 3 17 13 85 1
SMA Harapan Jaya, Cengkaren g 31743874
S MA H ar ap an K as ih , Pe nj ar in ga n 3 17 53 83 0
SMA Hasanuddin, Lagoa 31753843
SMA Hias 1, Manggarai 31714163
SMA Hikmah Pendidikan 31723935
SMA Home Schooling Kak Seto 00220012
SMAHutama,Pondok Gede,Jakarta
Timur00320014
SMA IbuPerwi, Seabudi 31714476
S MA I IB S Re pu bl ic o f I nd on es ia , C ik ar an g 0 13 20 00 9
SMA Insan Cendekia, Serpong 33320005
SMA Insan Kamil, Bogor 00820006
SMA Insani Kamil 00820006
SMA IPYakin, Cengkareng 31744115
SMA IpekaGreenVille,Tomang 31744985
SMA IPEKA Internasional, ChrisanSchool 00520020
S MA I pe ka P ur i, K em ba ng an S el at an 3 17 43 81 9
S MA I pe ka S un ter, J aka rta U ta ra 0 06 20 00 5
SMA Islam AlMar uf,Cijantung 31723841
S MA I sl am A l- Az ha r 1 , K eb ay or an B a ru 3 17 14 17 1
S MA I sl am Al -A zh ar 2, P ej at en B ar at 3 17 13 84 8
S MA I sl am A l- Az ha r 3 , K eb ay or an B a ru 3 17 13 85 7
S MA I sl am A l- Az ha r Ke ma ng , Ke ma ng 3 17 14 64 6
SMA Islam Al-Azhar, Bekasi 01320002
SMA Islam Al-Azhar,BSD Serpong 33320007
SMA Islam Al-Azhar,Kelapa Gading 00620011
SMA Islam Al-Azhar,Pegangsaan Dua 31753855
S MA I sl am A l- Az ha r, T an ju ng B ar at 0 02 20 00 3
S MA I sl am A l- Iz ha r, P on do k L ab u 0 02 20 00 2
S MA I sl am Ba ha gi a, J aka rt a Ba ra t 3 17 43 90 1
SMA Islam DianIlmu,Depok 01420004
SMA Islam Malahaya,C ijantung 31723835
S MA I sl am P B S ud ir ma n, C ij an tu ng 3 17 23 84 4
SMA Islam Village, Tangerang 31840012
SMA Jakarta Emerald School 00220010
SMA JakartaInternaonal School 00220007
SMA Janegara,Janegara 31724277
SMA Jaya, Kemang 31714186
SMAJohnCalvin Internasional School,
PuloMas00320010
SMA Joshua, Palmerah 00520016
SMA Jubele, Sunter Agung 31753787
SMA Kalam Kudus 1, Tangkilio 31744123
SMA Kalam Kudus2,Duri Kosambi 31743832
SMA Kalam Kudus3, GreenGarden 31744976