INTERNATIONAL STUDENT APPLICATION FORM
Study Program of Interest
Name
Date of Birth
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Gender
Male
Female
Country of Birth
Language(s) spoken at home
Permanent Home Address (e.g. overseas address)
Phone/Mobile
Email
Do you suffer from any medical condition/disability that may affect your studies?
YES
NO
If yes, please specify from the following
Hearing
Learning
Mobility
Visual
Medical
Other
Other, Please specify
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Administrative Process
Requirements
Alamat
Jl. Kusumanegara No.121, Miliran, Kec. Umbulharjo, Kota Yogyakarta, Daerah Istimewa Yogyakarta 55165
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