Prepare scanned documents before starting to fill in, consisting of KTP/Passport/Kitas, Kartu Keluarga, birth certificate, report card / diploma / graduation document, and photo (4x6).
Scan documents that can be uploaded in PDF, JPG, JPEG, and PNG formats, and are not larger than 5 MB in size.
Fill in each item of the question clearly and correctly.
Fields marked (*) are required.
After filling in, we will contact you within 1 x 24 hours on working days. If you register on a holiday, we will contact you on the following business day.
The form submission may take a while as the file attachments will be uploaded at once.
It is recommended to use a Desktop or Laptop.
Registrant Name (*)
What is your relationship with the Prospective Student? (*) SelfParentsGuardian
Registrant Email Address (*)
Registrant Telp. / WhatsApp Number (*)
* Required
Grade choice (*) DaycarePre-SchoolKindergartenPrimaryJunior HighSenior HighLearning Centre
Major choice, only for Senior High -IPAIPS
Full Name (*)
Nickname
Place of Birth (*)
Date of Birth
Gender (*) MaleFemale
Religion (*) IslamKatolikKristenHinduBudhaKonghucuAliran Kepercayaan
Nationality (*)
Language(s) spoken at home (*) Bahasa IndonesiaJavaEnglishMandarinOthers
Address (*)
Home Phone
Alternative Contact Phone Number / WhatsApp
Previous School Grade PGTKSDSMPSMA
From
To
Country
System of Education / School Name
Father's Full Name (*)
Father's Current Address (if different)
Father's Phone Number / WhatsApp (*)
Father's Date of Birth (*)
Father's Nationality (*)
Father's Occupation (*)
Father's Job Title (*)
Father's Name of Organization (*)
Mother's Full Name (*)
Mother's Current Address (if different)
Mother's Phone Number / WhatsApp (*)
Mother's Date of Birth (*)
Mother's Nationality (*)
Mother's Occupation (*)
Mother's Job Title (*)
Mother's Name of Organization (*)
Person to be contact if parents are not available:
Name (*)
Relationship (*)
Phone Number / WhatsApp (*)
KTP/Passport/Kitas (*)
Kartu Keluarga (*)
Birth Certificate (*)
SD/SMP Report/Graduation Certificate
Photo [Sized 4 x 6] (*)
