Registration Form Medical Bioinformatics

Registration Form "Medical Bioinformatics"

Fakultas Kedokteran, Universitas Pembangunan Nasional Veteran Jawa Timur
Ket. Program
Full Name
As per official ID/Student ID Card
Student ID Number (NIM/NPM)
Gender
Current Address
HP / WA Number
Emergency Number
Email Address
example@domain.com
Selected Program
Home University Information
University Name
Full name of home university (eg. Universitas Indonesia)
Faculty
eg. Faculty of Medicine/ Fakultas Kedokteran
Departement
eg. Sarjana Kedokteran/Profesi Dokter
Current Semester
Minimum Semester 4
Current GPA
on a 4.0 Scale
Course Information

Mata Kuliah Elektif yang akan diambil
Course Code
Minimum Semester 4
Course Name
Minimum Semester 4
Academic Period
Minimum Semester 4
Required Document

File Uploads
Scanned Student ID Card (KTM)
Scanned Academics Transcript (Latest)
Letter of Permission from Home Faculty
Declaration and Agreement

Komitmen
I Declare that all information provided is true and accurate
I agree to attend all online sessions as scheduled and complete all reuired assignments
Should be Empty:

Home University Information