Please fill up the application form. Full Name Gender Male Female Register For Asean Scholarship (International Student) Mailing Address City Postal Code Father's Name Father's Phone Mother's Name Mother's Phone Religion --------- Buddhist Catholic Christian Hindu Islam Kong Hu Cu ID Number Place of Birth Date of Birth 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 1995 1996 1997 1998 1999 2000 2001 2002 2003 Phone Number HP E-mail Major Accounting Business Administration Communication - Broadcasting Communication - Public Relations Communication - Visual Communication Design Electrical Engineering Environmental Engineering Industrial Engineering Information System Information Technology International Relations Law Management Mechanical Engineering Pendidikan Guru Sekolah Dasar High School Region Australia Austria East Timor Malaysia Philippines Singapore South Korea USA High School City High School (SMA) Other (please specify) Country Australia Austria East Timor Indonesia Malaysia Philippines Singapore South Korea USA Nationality Australians Chinese East Timorese Malaysians Vietnamese Passport No How do you know PresUniv? Facebook PresUniv Lecturer Alumni (PresUniv) Placement Test Invitation Alumni (Kakak kelas SMA) PresUniv Employee (Staff) Magazine (GoGirl, Media Kawasan, Info Kawasan, etc.) Google Yahoo! Newspaper Website School Visit Edufairs Friend PresUniv Student Other (please specify) I declare with full understanding and responsibility : To adhere totally and accept all national laws and regulations of the Republic of Indonesia. To strictly respect and loyal to the government of the Republic of Indonesia and all laws implemented by Indonesian government. To neither apply nor accept any paid occupation whatsoever while being a student in the Republic of Indonesia. To acknowledge all rules and regulations of President University and to fully adhere to them at all times.