Exchange, Internship and Short Course Immigration Form

IMPORTANT
Download the documents provided below!

Documents Template:

https://drive.google.com/drive/folders/15L61z_61LJNq0Lc94GhNN22rOR8OvglR

Short Course, Student Exchange and Internship Immigration Form

Personal Data & Required Files

ATTENTION!

All scanned documents must be in colour, clearly readable, not cut off and all scanned documents maximum file size 300 kb (jpg or pdf)

Name (Full Name)(Required)

Write as written on your Passport

Place of Birth(Required)

Write as written on your Passport

Date of Birth(Required)

Write as written on your Passport

Sex(Required)

Male

Female

Nationality(Required)

Passport Number(Required)

Issued(Required)

Expired(Required)

Marital Status(Required)

Spouse Name (for Married)

Phone/Mobile Number(Required)

Your Whatsapp Number, If you have Indonesian number please fill it

Social Media(Required)

Instagram/Facebook

Active Email(Required)

Faculty(Required)

Faculty in UMY

Department(Required)

Department in UMY

Origin Address(Required)

Input Village Name, Street Name, and House Number

City(Required)

Province/State(Required)

Country(Required)

Postal Code(Required)

Have You Ever Been to Indonesia?(Required)

Yes

Funding Source(Required)

UMY Scholarship

Self-Funded

Your University/Other Institutions

Required Documents

Please submit this required documents below

Recent Formal Passport Photo(Required)

Accepted file types: jpg, png, pdf, Max. file size: 1 MB.

Passport photo of yourself, wearing Formal Attire and should be in the red background

Scanned Passport Bio(Required)