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)*
Laki - LakiPerempuan
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
Agree
Agree
Should be Empty:

Home University Information