Registration – Office of International Affairs

Department of Information Technology, Study Program of D4 Informatics EngineeringDepartment of Electrical Engineering, Study Program of D4 Electrical Engineering

Department of Electrical Engineering, Study Program of D4 Digital Telecommunication NetworkDepartment of Civil Engineering, Study Program of D4 Construction Engineering Management

Department of Accounting, Study Program of D4 Management AccountingDepartment of Business Administration, Study Program of D4 Marketing Management

Department of Business Administration, Study Program of D4 English For Business and Professional CommunicationDepartment of Mechanical Engineering, Study Program of D4 Mechanical Production and Maintenance Engineering

FAMILY INFORMATION

FATHER/GUARDIAN NAME

FATHER/GUARDIAN EDUCATIONAL QUALIFICATION

FATHER/GUARDIAN OCCUPATION

FATHER/GUARDIAN ANNUAL INCOME

FATHER/GUARDIAN MOBILE NUMBER

MOTHER/GUARDIAN NAME

MOTHER/GUARDIAN EDUCATIONAL QUALIFICATION

MOTHER/GUARDIAN OCCUPATION

MOTHER/GUARDIAN ANNUAL INCOME

MOTHER/GUARDIAN MOBILE NUMBER

PARENT'S/GUARDIAN'S ADDRESS

PARENT'S/GUARDIAN'S CITY

PARENT'S/GUARDIAN'S COUNTRY

ACADEMIC ACHIEVEMENT

ACHIEVEMENT

LEVEL (LOCAL/NATIONAL/INTERNATIONAL)

NON-ACADEMIC ACHIEVEMENT

ACHIEVEMENT

LEVEL (LOCAL/NATIONAL/INTERNATIONAL)

MOTIVATION TO APPLY POLINEMA'S INTERNATIONAL PROGRAM: (CLEAR AND BRIEF EXPLANATION)

MOTIVATION TO STUDY IN INDONESIA: (CLEAR AND BRIEF EXPLANATION)

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