Admission Manual Online

MESSAGE FROM THE RECTOR
Dr. (Hon) Jonathan L. Parapak, M.Eng.Sc.

Chancellor/Rector
Lippo Village, February 24th, 2015
Welcome to UPH Global Campus,
world-class facilities, technology, and infrastructure. UPH also
Selamat datang di UPH Global Campus,
prepares students to be globally respected and appreciated by

modern industries and businesses.
This Admission Manual Book has been prepared to provide
UPH berkomitmen memberi Anda pelayanan terbaik dengan
you with comprehensive information regarding UPH
menyediakan pendidikan holistik dengan kualitas internasional,
Undergraduate Programs and enrollment procedures.
fasilitas, teknologi serta infrastruktur kelas dunia.
Buku Petunjuk Pendaftaran ini dipersiapkan untuk memberikan
UPH juga mempersiapkan mahasiswa agar dapat diakui secara
informasi menyeluruh mengenai Program Sarjana Strata 1 dan
global dan diapresisasi oleh industri dan bisnis modern.
prosedur penerimaan mahasiswa baru.

We welcome you to UPH Global Campus in Indonesia
We are eager to have you in the UPH family and introduce you
where learning is fun and excellent holistic education
to the vision of our university, which is: True Knowledge, Faith
is open to you.
in Christ, and Godly Character.
Selamat datang di UPH Global Campus, dimana kami
Kami ingin Anda dapat bergabung dengan kami dan
menyediakan proses pembelajaran yang menyenangkan
memperkenalkan Anda tentang visi UPH, yaitu: True
melalui pendidikan holistik terbaik di Indonesia.
Knowledge, Faith in Christ, dan Godly Character.

I pray that God will richly bless you during your study at UPH.
UPH is committed to serve you in the best possible ways, by
Saya berdoa agar Tuhan selalu memberkati Anda selama
providing a holistic and internationally qualified education, and
masa kuliah Anda di UPH.
UPH Online Admission Manual Academic Year 2016/2017
TABLE OF CONTENT
ii
Message from The Rector
Table of Content
ii
Online Admission Process
Important Notes
Admission & Scholarship Schedule
Undergraduate Program
Admission Requirements
Additional Requirements for Scholarship
Admission Test Regulations
Admission Statement
Scholarship Application Form
11
Art & Sport Scholarship Recommendation Form
12
Medical School Form
13
Health Declaration Form
14
Conservatory of Music Application Form
15
Conservatory of Music Recommendation Form
16
Full-English Class Application Form
17
Psychology Program Application Form
19
Submit details & send

required documents
Fill application details
Receive Form Number
Online Application Payment
Register Account Link:

http://online-admission.uph.edu
Regular
Admission
Scholarship
Admission
Admission Test
(Medical School
ONLY)
Direct Admission
Admission Test
(Medical School,
Homeschooling & PKBM)
Direct Admission
Selection
Result
Failed
Passed
Interview
Regular
Admission
Result
Scholarship
Result
Failed
Passed
Passed
Offering
Letter
Join UPH Festival as a New student
UPH Festival
Complete Re-registration Form

and submit to ADAK Bureau
at building A, 3rd fl., July 1-31
August, 2016, 07.30 - 16.00 WIB
Submit Re-Registration Form
Submit Uniform
Fitting Form & photo
for UPH Smartcard
E-mailed by bma@uph.edu
Payment Process
Based on the offering letter
ONLINE ADMISSION PROCESS
01
IMPORTANT NOTES
Application will be processed if the data and documents have met the requirements
and been accepted by UPH.
Aplikasi akan diproses apabila data dan dokumen sudah diterima lengkap oleh UPH.
Completed application will be processed within 14 working days.

Aplikasi yang sudah lengkap akan diproses dalam jangka waktu 14 hari kerja.
Admission result will be announced by 2 (two) methods:

Hasil akan diumumkan melalui 2(dua) metode:
1ST METHOD | METODE 1

Offering Letter sent to applicants address.
Offering Letter dikirimkan ke alamat calon mahasiswa
2ND METHOD | METODE 2

Offering Letter posted on Online Admission Website
1. Login to the following link: http://online-admission.uph.edu
2. Choose Admission Result to see OFFERING LETTER
Offering Letter ditampilkan di website pendaftaran online

1. Login ke link berikut ini: http://online-admission.uph.edu
2. Pilih hasil pendaftaran untuk melihat OFFERING LETTER
To complete application process please proceed the payment in accordance to Offering Letter.
E-payment procedure is available on http://uph.edu/prospective-students.html.
Untuk menyelesaikan proses pendaftaran silahkan lakukan pembayaran sesuai dengan Offering Letter.
Prosedur e-payment tersedia di http://uph.edu/prospective-students.html.
FORM NUMBER IS REQUIRED TO PROCEED THE PAYMENT.
PLEASE FIND YOUR FORM NUMBER IN YOUR OFFERING LETTER.
FORM NUMBER
NOMOR FORMULIR DIBUTUHKAN UNTUK MELAKUKAN PEMBAYARAN. NOMOR

FORMULIR DAPAT DITEMUKAN DALAM OFFERING LETTER ANDA.
NOMOR FORMULIR
If you need more detailed information, please contact us through:

Apabila anda memerlukan informasi yang lebih detail, dapat menghubungi kami melalui:
UPH GLOBAL CAMPUS
Jl. M.H. Thamrin Boulevard 1100 Lippo Village Tangerang 15811 Indonesia
(021) 5470901
(021) 5460910
undergraduate.admission@uph.edu
www.uph.edu
@uphkonsultasi
02
ADMISSION & SCHOLARSHIP SCHEDULE

ADMISSION SCHEDULE 2016/2017
ALL MAJORS EXCEPT MEDICINE
SUBMISSION DEADLINE
ADMISSION TEST
Early Admission 1
23 SEPT 2015
10 OCT 2015
Early Admission 2
13 NOV 2015
28 NOV 2015
Outside Jabodetabek
13 NOV 2015
28 NOV 2015
Term 1
15 JAN 2016
30 JAN 2016
Term 2
04 MAR 2016
19 MAR 2016
Term 3
29 APR 2016
13 MAY 2016
Term 4
01 JUL 2016
15 JUL 2016
SUBMISSION DEADLINE
ADMISSION TEST
MEDICINE
Early Admission 1
07 OCT 2015
10 OCT 2015
Early Admission 2
25 NOV 2015
28 NOV 2015
Outside Jabodetabek
25 NOV 2015
28 NOV 2015
Term 1
27 JAN 2016
30 JAN 2016
Term 3
10 MAY 2016
13 MAY 2016
SCHOLARSHIP SCHEDULE 2016/2017

ALL MAJORS EXCEPT MEDICINE
SUBMISSION DEADLINE
ADMISSION TEST
INTERVIEW SESSION
ANNOUNCEMENT
Best Student
28 AUG 2015
31 AUG - 11 SEPT 2015
28 SEPT 2015
Term 1
11 SEPT 2015
14 SEPT - 02 OCT 2015
19 OCT 2015
Term 2
30 0CT 2015
02 - 13 NOV 2015
30 NOV 2015
SUBMISSION DEADLINE
ADMISSION TEST
INTERVIEW SESSION
ANNOUNCEMENT
Term 1
28 AUG 2015
05 SEPT 2015
TBA
12 OCT 2015
Term 2
15 JAN 2016
30 JAN 2016
TBA
14 MAR 2016
MEDICINE
Schedule may be subject to change, latest info please check www.uph.edu
03
UNDERGRADUATE PROGRAM
1. Double Degree and Dual Degree Programmes are listed based on information by May 2015.
2. Prospective Students are not required to choose Double Degree or Dual Degree in the first year. These programmes are subject to rules and regulations applied.
3. Prospective Students must decide and choose Joint Degree from the first term and complete 2 (two) application package (UPH & RMIT Application).
MAJOR
FULL ENGLISH
CLASS
DOUBLE
DEGREE
Management
Computer Technology
Applied Mathematics
IPA & IPS
Accounting
Information Systems
IPA & IPS
Applied Communication
Sciences*
IPA & IPS
Government and
Global Affairs
IPA & IPS
Political Science
IPA & IPS
Law
IPA & IPS
Architecture
IPA & IPS
Visual Communication Design
IPA & IPS
Interior Design
IPA & IPS
Product Design
IPA & IPS
Applied
Mathematics
Informatics
Management
IPA
Biotechnology
IPA
Electrical Engineering
IPA
Industrial
Engineering
IPA & IPS
Civil Engineering
IPA
Food Technology
IPA
Information System
Accounting
IPA & IPS
Informatics
Applied Mathematics
IPA & IPS
Computer Technology
Management
IPA & IPS
Faculty of Psychology
Psychology
IPA & IPS
Conservatory of Music
Music
IPA & IPS
Medical School
Medicine
IPA
Hospitality Management
IPA & IPS
Travel Industry Management
IPA & IPS
School of Philosophy
& Divinity
Philosophy
IPA & IPS
Faculty of Nursing and Apllied

Health Sciences**
Nursing
IPA & IPS
Faculty of Education
-Teachers College**
Biology Education, Economics

Education, English Education,
Mathematics Education,
Primary Education
***
IPA & IPS
FACULTY
Business School
Faculty of
Social and Political
Sciences
School of Law
School of Design
Faculty of Science and

Technology
Faculty of
Computer Science
School of Hospitality
and Tourism
* Available also in Online Learning

** For admission requirements and further information, please call :
Faculty of Nursing : (021) 546 0901 ext. 3437
Teachers College : (021) 546 6057 ext. 2613/2637
04
DUAL/JOINT HIGH SCHOOL

DEGREE
MAJOR
*** Only for English Education
ADMISSION REQUIREMENTS
COMPULSORY REQUIREMENTS FOR ALL MAJORS
NO
DOCUMENTS
National
Curriculum
IGCSE
O Level
IGCSE
A/AS Level
International
Baccalaureate
Others
Admission Statement (see page 9)
Stamp duty Rp.6000,- (put on Admission Statement page 9)
A copy of TOEFL IBT /IELTS Certificate with minimum score 61 for TOEFL IBT or
5.5 for IELTS (only for non Indonesian passport Holder/WNA)
A legalized copy of Academic Records : Grade 10 and 11
Full-English Classes Application Form (see page 17)
A copy of valid ID Card (KTP/Kartu Pelajar/SIM/Passport)
A legalized copy of Junior High School National Examination/UN SMP
A legalized copy of O Level/A Level/AS Level IGCSE Report/Certificate

(min 5 subject)
A legalized copy of IB Predicted
ADDITIONAL REQUIREMENTS FOR SCHOOL OF DESIGN

DOCUMENTS
NO
1
One page Essay: Why I Choose X Major Study Program
Color Blindness Test Certificate by Ophthalmologist/Oculist
Architecture: 3 (three) hand drawings/portfolios with Drawing Theme: Free, Interior, and Exterior
DKV: 3 (three) hand drawings/portfolios with Media of Portfolio: Pencil, Paint, and Free Media
Product Design: 2 hand drawings with Media: A3-size Paper & Pencil.
Industry Based Design (gadget, home appliances, automotive, furniture, stationary, etc)
Handicraft based design (jewelry, furniture, etc). Both preferably an innovation, complete with the uniqueness explanation.
Interior Design: For portfolio requirements, please see interior.sod.uph.edu
ADDITIONAL REQUIREMENTS FOR CONSERVATORY OF MUSIC

DOCUMENTS
NO
1
Conservatory of Music Application Form & Conservatory of Music Recommendation Form (see page 17-18)
1 (one) video audition in WMA/MP4/AVI format for each concentration
For procedure and audition requirements (include sample of Theory and Solfeggio Exam), please see http://music.uph.edu/admission/procedure.html
ADDITIONAL REQUIREMENTS FOR MEDICAL SCHOOL

DOCUMENTS
NO
1
Medical School Application Form & Health Declaration Form (see page 15-16)
Color Blindness Test Certificate by Ophthalmologist / Oculist
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.
2 Recent Photo size 3x4 using white collared shirt with blue background
ADDITIONAL REQUIREMENTS FOR FACULTY OF PSYCHOLOGY

DOCUMENTS
NO
1
Psychology Program Application Form (see page 19)
05
ADDITIONAL REQUIREMENTS
FOR SCHOLARSHIP
COMPULSORY REQUIREMENTS FOR ALL MAJORS
NO
06
DOCUMENTS
Academic
Achievement
Category
Limited
Financial
Category
Art
Achievement
Category
Sport
Achievement
Category
Scholarship Application Form (see page 11)
Copy of Family Card/Kartu Keluarga
A-500-word English Essay about:

Why I Choose X Major at UPH as a Stepping Stone for My Career
(Except School of Design and Faculty of Medicine)
Copy of achievement certificate in any fields
A statement letter of family financial condition, issued by: Church

(for Christian/Catholic) or RT/RW/Kelurahan (for other religions)
Copy of electricity bill for the last 3 months
Copy of water bill for the last 3 months
Copy of landline telephone bill for the last 3 months
Copy of the last Pajak Bumi dan Bangunan (PBB) payment
10
Copy of Parents payslip of income
11
Art & Sport Scholarship Recommendation Form (see page 12)
12
Recent photo (postcard size) using team uniform

(write your name, height and weight behind the photo)
13
Copy of sports certificate of performance

(province/national/international level)
14
Recommendation Letter from Komite Olahraga National Indonesia (KONI)
ADMISSION TEST REGULATIONS

BEFORE THE TEST
1. Participant is required to wear proper attire and shoes.
2. Participant is required to bring their own stationery (pen, 2B pencil, eraser, and calculator), Admission Test Participant
Card and original ID card (KTP, driving license or other identification which has photograph of participant). Participant who does
not bring the requirements must report to the Admission Test Committee.
3. Participant must be present in the test room 30 minutes before the test begin. Participant who is late is allowed to
participate in the test without additional time.
SEBELUM UJIAN BERLANGSUNG
1. Peserta wajib berpakaian rapi, sopan, dan bersepatu tertutup.
2. Peserta wajib membawa alat tulis (pena, pensil 2B, penghapus, dan kalkulator) milik sendiri, Kartu Tanda Peserta Ujian
Saringan Masuk, dan kartu identitas asli (KTP, SIM atau identitas lainnya yang memuat pasfoto peserta). Peserta yang tidak
membawa perlengkapan tersebut, wajib melapor kepada panitia Ujian Saringan Masuk.
3. Peserta wajib berada di ruang ujian 30 menit sebelum ujian dimulai. Peserta yang terlambat diperbolehkan mengikuti ujian
tanpa ada penambahan waktu.
DURING THE TEST
1. Participant is prohibited to interact with other participants.
2. Participant is not allowed to leave the test room without permission from the supervisor.
3. Participant should stop doing the test when there is a time up notification.
4. Breaking the Admission Test Regulations will cause participants a disqualification from the test and cancellation
on the registration process.
SELAMA UJIAN BERLANGSUNG
1. Peserta dilarang berinteraksi dengan peserta lain.
2. Peserta dilarang meninggalkan tempat ujian tanpa izin dari pengawas.
3. Peserta wajib menghentikan pekerjaannya setelah ada pemberitahuan bahwa waktu ujian telah berakhir.
4. Peserta akan dianggap gugur dan dibatalkan proses pendaftarannya jika melanggar tata tertib Ujian Saringan Masuk.
IMPORTANT
Participants must not cheat during the Admission Test under any conditions. If UPH finds out later that the participant has
cheated on the test, then the participant will be terminated from UPH and no fees will be refunded.
PENTING
Peserta dilarang melakukan kecurangan saat Ujian Saringan Masuk. Apabila di kemudian hari diketahui bahwa mahasiswa aktif
telah melakukan kecurangan saat ujian, mahasiswa yang bersangkutan akan dikeluarkan dari UPH tanpa ada pengembalian
biaya kuliah yang telah dibayarkan.
07
ADMISSION STATEMENT
Copy 1 : Admission Office
READ CAREFULLY BEFORE YOU SIGN!

Bacalah dengan seksama sebelum Anda menandatangani!
I, the undersigned:
Saya yang bertanda tangan di bawah ini:
Form Number
Nomor Formulir
Full Name
Nama Lengkap
Hereby affirm that,

dengan ini menegaskan bahwa,
1. I understand that the education program of UPH/STPPH is characterized by the Christian Faith, based on the Pancasila and UUD 1945.
Mengetahui bahwa penyelenggaraan pendidikan di UPH/STPPH bercirikan iman Kristiani dan berdasarkan Pancasila dan UUD 1945
2. I will not engage 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 examination/drug examination at any given time by UPH/STPPH.
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 tidak lulus dalam tes kesehatan/tes narkoba yang sewaktuwaktu akan dilakukan oleh pihak UPH/STPPH.
3. I am willing to participate in a blood/urine examination at any given time by UPH/STTPH.
Bersedia melakukan tes darah/urine yang sewaktu-waktu akan dilakukan oleh pihak UPH/STTPH.
4. All documents that I submit are legal. I am fully responsible for any consequences and willing to accept all sanctions for any INCORRECT information.
Semua dokumen yang dikumpulkan ke UPH adalah sah. Saya bersedia menanggung segala sanksi apabila informasi yang saya berikan TIDAK BENAR.
5. I am willing to accept sanctions (Drop Out) from UPH/STPPH unless I can submit the copy of High School Certificate or High School
Certificate Equivalency before the end of 2nd term, even though the tuition fee has been paid.
Bersedia menanggung sanksi (dikeluarkan) dari UPH/STPPH jika tidak dapat menyerahkan fotokopi ijazah SMA Nasional/Surat Penyetaraan
Ijazah sebelum term 2 berakhir walaupun sudah diterima dan membayar uang kuliah.
6. For Faculty of Psychology: I acknowledge and agree to follow the curriculum in Faculty of Psychology that is enriched with Christian values.
I am fully aware that there will be individual counseling as a prerequisite to continue study in the next terms (2nd term).
Untuk Fakultas Psikologi: Saya mengetahui dan menyetujui untuk mengikuti pembelajaran di Fakultas Psikologi UPH yang diperkaya dengan
nilai-nilai Kristiani. Saya menyadari sepenuhnya bahwa akan ada konseling pribadi sebagai prasyarat untuk melanjutkan pembelajaran pada
term berikutnya (term 2).
7. I understand that Double Degree and Dual Degree programmes will start after the first year of class. These programmes are subject to the applied rules and regulations .
Saya mengerti bahwa program Double Degree dan Dual Degree akan dilaksanakan setelah tahun pertama perkuliahan, sehingga akan ada
kemungkinan terjadi perubahan.
8. I understand that if the quota of a class is full, UPH has the right not to accept any payment although it is before payment deadline.
Saya mengerti bahwa jika batas maksimum kapasitas jumlah mahasiswa yang dapat diterima sudah tercapai, maka UPH berhak menolak
pembayaran yang akan dilakukan meskipun belum mencapai batas akhir pembayaran.
9. All payments transferred to Pelita Harapan Foundation are declared as the final decision, finalized by the depositor, cant be refunded for any conditions.
10.
11.
12.
13.
Semua pembayaran yang telah disetor ke Yayasan Universitas Pelita Harapan dinyatakan sebagai keputusan akhir dari pihak penyetor
dan tidak dapat ditarik kembali dengan alasan dan kondisi apapun.
I along with my parents hereby acknowledged and confirmed our acceptance on the consequences of provisions number 9 as stated above and
therefore we will not file any law suit in connection with provision number 9 above.
Saya bersama dengan orang tua saya dengan ini menegaskan bahwa kami sudah mengerti dan menerima konsekuensi dari ketentuan point
9 di atas dan oleh karena itu kami tidak akan mengajukan gugatan hukum apapun di kemudian hari sehubungan dengan ketentuan nomor 9
tersebut di atas.
All documents that I submit fully belong to UPH and UPH will not entertain requests to return the documents for any reason.
Semua dokumen yang dikumpulkan sepenuhnya menjadi milik UPH dan tidak dapat dikembalikan dengan alasan apapun.
I agree to abide by the Regulations stated by the University, both now and in the future.
Bersedia mentaati Statuta, Peraturan Tata Tertib Kampus, dan peraturan lain yang telah dan akan diberlakukan.
I have read, known, and understood the regulations and registration requirements stated in this Admission Manual.
Telah membaca, mengetahui, mengerti ketentuan dan persyaratan pendaftaran dalam Buku Petunjuk Admisi ini.
,
Place | Tempat
Date | Tanggal
Stamp Duty/Materai
Rp. 6000
potong disini
Please sign on the stamp duty/

Harap tanda tangan di atas materai
PARENT/GUARDIANS SIGNATURE & FULL NAME

Tanda Tangan & Nama Lengkap Orang Tua/Wali
PROSPECTIVE STUDENTS SIGNATURE & FULL NAME

Tanda Tangan & Nama Lengkap Calon Mahasiswa
09
SCHOLARSHIP APPLICATION FORM

SCHOLARSHIP APPLICATION FOR ALL CATEGORIES
I, the undersigned:
Form Number
Nomor Formulir
Full Name
Nama Lengkap
Social, Organizational or Leadership Activities

Aktivitas sosial, organisasi atau kepimpinan
Student Council
Spiritual Activities
Red Cross Youth Council
Martial Arts
Sport
Scout
Choir/Vocal Group
Flag-raising Squad
Band/Orchestra
Others,
Language Club
Achievements (Senior High School Level)
Penghargaan yang pernah diperoleh (di tingkat SMA)
(Please attach certificate that support this information)

(Lampirkan fotokopi sertifikat sebagai bukti yang mendukung informasi ini)
Religious Activities at Church

Aktivitas keagamaan di gereja
If you are Christian/Catholic, please fill the following information:

Jika Anda beragama Kristen/Katolik, harap isi keterangan berikut ini:
Church :
Nama Gereja
Address :
Alamat Gereja
Join ministry/activities
:
Mengikuti kegiatan pelayanan
Scholarship Category | Kategori Beasiswa
Please give tick (v) in your option | Silahkan berikan tanda (v) dalam pilihan Anda
Academic Achievement | Prestasi Akademik
Art Achievement | Prestasi Seni
Limited Finance | Kondisi Ekonomi Terbatas
Sport Achievement | Prestasi Olahraga
I certify that the above information is true and correct.

Saya tegaskan informasi di atas adalah benar.
,
Place | Tempat
Date | Tanggal
potong disini
PROSPECTIVE STUDENTS SIGNATURE & FULL NAME

PARENT/GUARDIANS SIGNATURE & FULL NAME

11
ART & SPORT SCHOLARSHIP

RECOMMENDATION FORM
SCHOLARSHIP APPLICATION FOR ART ACHIEVEMENT OR SPORT ACHIEVEMENT CATEGORY
I, the undersigned:
Coach/Teacher Full Name
Nama lengkap Pelatih/Guru
High School/Institution Name

Nama Sekolah/Institusi
ART
Coach/Teacher of:
Pelatih/Guru
Guitar
Drum
Vocal
Acting
Bass
Piano
Modern Dance
Photography
Keyboard
Choir
Traditional Dance
Video Editing
SPORT
Coach
Pelatih
Volleyball
Basketball
Soccer
Swimming
Badminton
Futsal
Please recommend this prospective student regarding his/her scholarship application:

Mohon untuk merekomendasikan Calon Mahasiswa ini pada pendaftaran Program Beasiswa:
Form Number
:
Nomor Formulir
Full Name
Nama Lengkap
Height
Tinggi Badan
Position in Team
Posisi pada Tim
cm
Weight
Berat Badan
kg
: 1. __________________________ 2. __________________________ 3. __________________________

Saya tegaskan informasi diatas adalah benar.
Coach/Teacher,
Pelatih/Guru
,
Place | Tempat
Date | Tanggal
Coach/Teachers Signature & Full Name + Stamp (if any)

Tanda Tangan & Nama Lengkap Pelatih/Guru + Cap (jika ada)
12
MEDICAL SCHOOL FORM

PROSPECTIVE STUDENT
Form Number
Nomor Formulir
Full Name
Nama Lengkap
Place & Date of Birth

:
Tempat & Tanggal Lahir
Name of Parent
Nama Orang Tua
Name of Family Doctor

Nama Dokter Keluarga
COMMUNITY INVOLVEMENT
Please provide a brief summary of all volunteering, caring, community leadership, religious services and organizations that you have participated in.
Jelaskan secara singkat semua bentuk partisipasi Anda pada kegiatan relawan, kepemimpinan, pelayanan keagamaan dan organisasi.
PERSONAL ACHIEVEMENT
Please provide a brief summary of your current sports, artistic activities, hobbies, and interests.
Jelaskan secara singkat tentang kegiatan olahraga, seni, hobi, dan minat Anda saat ini.
Prospective Student,
Calon Mahasiswa
,
Place | Tempat
Date | Tanggal
potong disini
Prospective Students Signature & Full Name

13
HEALTH DECLARATION FORM

If you are accepted as a student of the Medical School, you will be required to complete the Health Declaration Form prior to joining for your classes. The
information provided to us is confidential and will not be used for any other purposes except providing support for the student.
Jika Anda diterima sebagai mahasiswa Fakultas Kedokteran, Anda wajib melengkapi Formulir Pernyataan Kesehatan sebelum bergabung di dalam kelas.
Informasi yang diberikan kepada kami bersifat rahasia dan tidak akan digunakan untuk tujuan lain kecuali memberikan dukungan bagi siswa.
I, the undersigned:
Full Name
:
Nama Lengkap
HEALTH DECLARATION
Pernyataan
No.
YES
Ya
Do you have, or have you ever had, any medical conditions or operations in the past 5 years?
Apakah Anda memiliki atau pernah memiliki kondisi medis tertentu atau pernah menjalani operasi dalam 5 tahun terakhir?
Are you at present attending a doctor for medical care, taking any medication or on a waiting list for
hospital assessment or treatment?
Apakah Anda saat ini sedang akan menjalani perawatan medis, mengkonsumsi obat-obatan?
Do you have impairment/disability (physical or metal) or specific learning disability which may affect your ability to study in
UPH Medical School?
Apakah Anda memilki kekurangan/cacat (fisik atau mental) atau ketidakmampuan belajar yang dapat mempengaruhi proses
belajar Anda di Fakultas Kedokteran UPH?
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 orang di sekitar Anda yang pernah dirawat karena TBC?
Have you had a cough for more than 3 weeks?

Apakah Anda menderita batuk lebih dari 3 minggu?
Have you coughed up blood?

Apakah Anda pernah batuk berdarah?
Have you had any unexplained weight loss?

Apakah Anda pernah kehilangan berat badan tanpa sebab yang dapat dijelaskan?
Have you suffered from night sweats or fever?

Apakah Anda menderita demam atau keringat berlebih saat tidur?
10
Have you ever had any kind of back, joint or muscle problem?
Apakah Anda mengalami sakit punggung, sendi atau masalah otot?
11
Have you ever had, Dermatitis, Eczema, Psoriasis or any other skin condition?
Apakah Anda pernah mengalami: Dermatitis, Eksim, Psoriasis atau penyakit kulit lainnya?
12
Have you ever had any mental illness which might affect your ability to study and practice medical science?
(including anxiety, depression, self-harm, eating disorders, psychological or emotional problems)
Pernahkah Anda punya penyakit mental yang berpotensi mempengaruhi kemampuan Anda dalam belajar dan
mempraktekkan ilmu medis?
13
Have you ever had a drug, tobacco, nicotine or alcohol problem?

Apakah Anda pernah memiliki masalah yang terkait dengan narkoba, tembakau, nikotin atau alkohol?
14
Do you have any difficulty with your eyesight, including color blindess?
Apakah Anda memiliki kesulitan dengan penglihatan Anda, termasuk buta warna?
15
Do you have difficulty in hearing?

Apakah Anda memiliki kesulitan pendengaran?
16
Have you ever suffered from any of the following: loss of consciousness including fainting attacks, blackouts or epilepsy?
Pernahkah Anda menderita kehilangan kesadaran termasuk pingsan atau pingsan karena epilepsi
17
Have you ever suffered from any of the following: heart disease, diabetes, Hypertension or any other medical illness?
Pernahkah Anda pernah mengalami; penyakit jantung, diabetes, Hipertensi atau penyakit medis lainnya?
18
Have you ever suffered from chest or lung problems: Asthma, Bronchitis?
Apakah Anda pernah mengalami masalah paru-paru: Asma, atau Bronkitis?
19
Have you ever had any allergies, including to drugs, food or latex?
Pernahkah Anda punya alergi, termasuk alergi terhadap obat-obatan, makanan atau lateks?
20
Have you ever received treatment for bowel or gastric problems?

Apakah Anda menerima perawatan karena masalah usus atau lambung?
21
Do you have any other medical conditions not previously mentioned in questions 1 15 above?
Apakah Anda pernah mengalami masalah kesehatan lainnya yang tidak disebutkan pada pertanyaan 1 15?
22
Have you been vaccinated for Hepatitis? If you have, what was the dosage?
Apakah Anda pernah mendapat vaksin Hepatitis? Jika ya, berapa dosisnya?
23
Have you had any episode of Jaundice/Hepatitis? If yes, please submit the Laboratory Blood Report. If you already committed,
you have to submit the Laboratory Blood Report to FK Admission Office, FK Building 2nd fl, on August 1-10, 2016 during weekdays.
Apakah Anda pernah menderita Hepatitis? Jika ya, harap mengirimkan Hasil Periksa Darah dari laboratorium ke kantor
Administrasi FK, Gedung FK lt.2, pada tanggal 1-10 Agustus 2016 di hari kerja.

Medical School New Student,

Mahasiswa Baru Fakultas Kedokteran
Place | Tempat
Signature & Full Name
Date | Tanggal
NO
Tidak
DETAILS
Keterangan
Tanda Tangan & Nama Lengkap
14
CONSERVATORY OF MUSIC
APPLICATION FORM
NOTES
1. Complete the Student Information form.

2. Check the admission requirement and procedure at www.music.uph.edu
3. Applicants for all concentrations have to submit a good quality DVD/VCD recording which contains three contrasting pieces.
4. Applicants may be asked to take a Music Placement Test (Music Theory and Solfeggio).
5. The Recommendation form (p.16) must be completed by the referee.
Form Number
Nomor Formulir
Full Name
Nama Lengkap
High School Name

Nama Sekolah
Preferred Consentration (Put Rank 1st, 2nd, and 3rd based on priority)
Konsentrasi Pilihan (Pilih berdasarkan prioritas 1, 2, dan 3)
Arts Management
Jazz and Pop Performance
Church Music
Preferred major instrument: (Please tick one only)

Instrumen Pilihan: (Pilih salah satu)
Non-classical Instrument
Classical Instrument
Piano
Clarinet
Music Education
Vocal
Bassoon
Vocal
Guitar
French-Horn
Electric Guitar
Classical Performance
Music Therapy
Violin
Trumpet
Electric Bass
Viola
Trombone
Drum
Composition
Sound Design
Cello
Tuba
Saxophone
Contra-Bass
Percussion
Flute
Harp
Oboe
Piano
Why did you choose UPH Conservatory of Music? Describe.

Mengapa Anda memilih Conservatory of Music UPH? Jelaskan.
How does music impact your life?

Bagaimana musik memberi dampak bagi hidup Anda?
Why did you choose your 1st choice consentration?

Mengapa Anda memilih pilihan konsentrasi pertama?
Who is your favorite composer or performer? Why?

Siapa komposer/performer favorit Anda? Mengapa?
Why did you choose your 2nd choice consentration?

Mengapa Anda memilih pilihan konsentrasi kedua?
Ensemble playing experience: Yes/No

Apakah Anda pernah memainkan ensemble: Ya/Tidak
Why did you choose your 3rd choice consentration?

Mengapa Anda memilih pilihan konsentrasi ketiga?
Did you apply to a Conservatory of Music other than UPH? Yes/No

Apakah Anda mendaftar ke jurusan Musik selain di UPH? Ya/Tidak
Mention the repertoire that you have learned!

Sebutkan repertoire yang pernah Anda pelajari!
Recent teacher name: _______________________________

Institution/music schools: ___________________________
Music award ever received (if any): ____________________
Briefly, describe your goals and what influence you to plan a career in music.
Jelaskan secara singkat mengenai tujuan dan dampak yang Anda dapat berikan saat berkarir di bidang musik.
potong disini
15
CONSERVATORY OF MUSIC
RECOMMENDATION FORM
REFEREE | PEMBERI REKOMENDASI
Full Name
Nama Lengkap
Institution/School of Music :
Nama Sekolah Musik
Phone Number
Nomor Telepon
Mobile Phone
Nomor Handphone
Length of Courses
Lama Belajar
Year
Tahun
Frequency/week :
Frekuensi/minggu
Hours/Course :
Jam/Kelas
Please circle the most appropriate answer based on prospective students music skill.
Silahkan lingkari pilihan yang sesuai dengan opini Anda mengenai keterampilan musik Calon Mahasiswa berdasarkan
keterampilan musik calon mahasiswa
1. Technical strength in playing the instrument:
a. Solid
b. Need supervision to be solid
c. Difficult to be solid
6. Level of diligence
a. Show a great enthusiasm to learn his/her musical pieces
b. Has ambition to develop his/her musical ability yet less consistent
c. Depends on mood, always need support to gain motivation and inspiration
2. Musical strength in playing the instrument:

a. Sensitive and able to perform an outstanding musical
showing diligence to do the work
b. sensitive yet need guidance
c. less sensitive
7. Level of speed to grasp knowledge

a. Shows rapid development in a short amount of time
b. Not too fast in showing diligence to do the work ability by his/her own intitative
c. Not too fast and less careful over the given correction not too fast and
less careful over the given correction
3. Knowledge of Theory of Music

a. Very Good in making harmony using S-A-T-B format
b. Know basic format in writing S-A-T-B
c. Doesnt have a deep knowledge in theory of music
8. Your opinion about the maturity of your student

a. Mature
b. Quite mature
c. Immature
4. Knowledge about aural training

a. Well trained in soffegio/prima vista for example:
ritmic dictation, melody, interval, and harmony
b. Has sufficient session in aural training but only before
the examination period.
c. Havent received aural training yet
9. Level of confidence to see your student will be able to succeed studying

at UPH Conservatory of Music with his/her chosen rhythmic dictation,
melody, interval, and harmony concentration
a. Very sure 80%-100%
b. Sure 60%-80%
c. Unsure 50%-60%
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 received any guidance
10. Your consideration for the student to get scholarship

a. Highly recommended
b. Recommended
c. Less recommended
REFEREE COMMENTS REGARDING SCHOLARSHIP APPLICANT | KOMENTAR PEMBERI REKOMENDASI MENGENAI PEMOHON
Referee,
Pemberi Rekomendasi
,
Place | Tempat
Date | Tanggal
Referees Signature & Full Name + Stamp (if any)

Tanda Tangan & Nama Lengkap Pemberi Rekomendasi + Cap (jika ada)
16
FULL-ENGLISH CLASSES
APPLICATION FORM
PROSPECTIVE STUDENT WHO APPLY TO FULL ENGLISH CLASS IS REQUIRED TO FILL THIS FORM
Form Number
Full Name
Major
Phone Number
E-mail Address
Mobile Number :
I will submit TOEFL/IELTS score by:

Take TOEFL Test at UPH Language Center. Please check the update schedule at www.uph.edu (Info Center).
Submit a copy of TOEFL/IELTS Certificate (Submission deadline: June 26, 2015)
* we accept only TOEFL/IELTS results from LIA, AMINEF, TOEFL/IELTS International
1. This form is required ONLY for Prospective Student who apply to the available Full English Class as listed below:
- Management
- Accounting
- Communication
- International Relation
- Law
- Food Technology
- Hospitality Management
REQUIREMENTS
2. Prospective Students must submit a copy of valid certificate of TOEFL/IELTS.

3. The minimum score to apply Full English Class:
TOEFL Paper Based Test
: 500
TOEFL Internet Based Test : 59 60
IELTS
: 5.0
If the requirement above can not be fulfilled, the Prospective Students could not apply Full English Class.
4. Full English Class has limited seats. All applications will be processed and selected by UPH. The Final decision could be ACCEPTED or
NOT, and is an absolute decision.
potong disini
____________, __________________
Place
Date
Received by,
Verified by,
( ___________________________________ )
( ___________________________________ )
Admission Staffs Signature & Full Name
( ___________________________________ )
UPH Language Centers Signature & Full Name
17
16
UPH Admission Manual Academic Year 2015/2016
PSYCHOLOGY PROGRAM
APPLICATION FORM
PSYCHOLOGY PROGRAM
I, the undersigned:
Form Number
Nomor Formulir
Full Name
Nama Lengkap
Phone/Mobile Number
Nomor Telepon
E-mail address
Alamat E-mail
Preferred Concentration | Konsentrasi Pilihan
Please give tick (v) in your option | Silahkan berikan tanda (v) dalam pilihan Anda
Psychology | Psikologi
Psychology & Entreprenurship | Psikologi & Kewirausahaan
,
Place | Tempat
Date | Tanggal

Parent/Guardians Signature & Full Name

potong disini
19

Admission Manual Online

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MESSAGE FROM THE RECTOR

Dr. (Hon) Jonathan L. Parapak, M.Eng.Sc.

Lippo Village, February 24th, 2015

Welcome to UPH Global Campus,

world-class facilities, technology, and infrastructure. UPH also

Selamat datang di UPH Global Campus,

prepares students to be globally respected and appreciated by

This Admission Manual Book has been prepared to provide

UPH berkomitmen memberi Anda pelayanan terbaik dengan

you with comprehensive information regarding UPH

menyediakan pendidikan holistik dengan kualitas internasional,

Undergraduate Programs and enrollment procedures.

fasilitas, teknologi serta infrastruktur kelas dunia.

Buku Petunjuk Pendaftaran ini dipersiapkan untuk memberikan

UPH juga mempersiapkan mahasiswa agar dapat diakui secara

informasi menyeluruh mengenai Program Sarjana Strata 1 dan

global dan diapresisasi oleh industri dan bisnis modern.

prosedur penerimaan mahasiswa baru.

where learning is fun and excellent holistic education

to the vision of our university, which is: True Knowledge, Faith

in Christ, and Godly Character.

Selamat datang di UPH Global Campus, dimana kami

Kami ingin Anda dapat bergabung dengan kami dan

menyediakan proses pembelajaran yang menyenangkan

memperkenalkan Anda tentang visi UPH, yaitu: True

melalui pendidikan holistik terbaik di Indonesia.

Knowledge, Faith in Christ, dan Godly Character.

Saya berdoa agar Tuhan selalu memberkati Anda selama

providing a holistic and internationally qualified education, and

masa kuliah Anda di UPH.

UPH Online Admission Manual Academic Year 2016/2017

Message from The Rector

Online Admission Process

Admission & Scholarship Schedule

Additional Requirements for Scholarship

Admission Test Regulations

Scholarship Application Form

Art & Sport Scholarship Recommendation Form

Medical School Form

Health Declaration Form

Conservatory of Music Application Form

Conservatory of Music Recommendation Form

Full-English Class Application Form

Psychology Program Application Form

UPH Online Admission Manual Academic Year 2016/2017

UPH Online Admission Manual Academic Year 2016/2017

Submit details & send

Fill application details

Receive Form Number

Online Application Payment

Register Account Link:

Join UPH Festival as a New student

Complete Re-registration Form

Submit Re-Registration Form

ONLINE ADMISSION PROCESS

Completed application will be processed within 14 working days.

Admission result will be announced by 2 (two) methods:

1ST METHOD | METODE 1

Offering Letter dikirimkan ke alamat calon mahasiswa

2ND METHOD | METODE 2

Offering Letter ditampilkan di website pendaftaran online

NOMOR FORMULIR DIBUTUHKAN UNTUK MELAKUKAN PEMBAYARAN. NOMOR

If you need more detailed information, please contact us through: