AJOU UNIVERSITY

Application for Admission

Office of International Affairs

 Admission Information
1. What is your status ?
( ) student from Partner universities ( ) Free-Paying study Abroad
2. Which program are you applying for ? (Multiple Check Possible)
( ) Exchange Student (Spring or Fall) ( ) International Summer School
3. For which session are you applying for ? (Multiple Check Possible)
( ) Fall (September) year 2011 ( ) Spring (March) Year 2011 ( ) Summer (July) Year 2011

 Personal Information
1. Name. Given Name (First Name): Efa 4. Permanent Address
Middle Name Silvia Jl Ceria 2 Blok D1 No.6 ,Bekasi Barat
Family Name (Last Name Silvia Jl Pancawarga No.15 .Kalimalang
2. Mailing Address 5. Place of Birth
City: Bekasi
Country : West Java
Phone (Include Country Code) 6. Sex: ( ) Male ( ) Female
(021)-8813112 7. Date of Birth:
3. University Address for Admission Package Month: September Day:2 Year:1991
Name : Padjajaran University 8. Passport No :
Title : 9. Citizenship : Indonesia
Address : Universitas Padjajaran 10. Emai: Efasilvia@rocketmail.com
Jl Dipati Ukur No.35 Bandung 40132
Indonesia
Phone : 62-22-2508122
Fax : 62-22-2508122
Email :
 Current Academic Informationn
 1. Name of Institution 3. Year of Entry : 2009
Padjajaran University 4. Major:
2. What year will you in at Ajou? (ex 1,2,3,or 4) 5. Majoring College (or School,Faculty)
Undergraduate :
Graduate :

 Emergency Notification
1. Name: 2. Phone:
*Relationship: 3. Email:
 Required Documents for Admission:
*Please check what you enclose
1. ( )Application Form 2. ( )Housing Application and Resident Consent Form
3. ( )Self-Introduction Essay 4. ( )Official Transcript
5. ( )One recommendation Letter 6. ( )Copy of Pasport
7. ( )Application Fee of 80.000 Korean Won (Fee-paying students only)
Applicant Signature: Date:

Approval of Home Institution (Wived for Fee-Paying Study Abroad Students)

Mr. Ramdan Panigoro,MD.,M.Sc.,Ph.D
Signature: Date: