JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
BBK Internasional 2026 Registration
* Indicates required question
Email
*
Your answer
Full Name
*
Your answer
Gender
Male
Female
Clear selection
Active Whatsapp Phone Number
*
Your answer
Student Number (NIM)
*
Your answer
Faculty
*
Medicine (Kedokteran)
Dentistry (Kedokteran Gigi)
Veterinary Medicine (Kedokteran Hewan)
Economics and Business (Ekonomi dan Bisnis)
Law (Hukum)
Social and Political Science (Ilmu Politik dan Sosial)
Psychology (Psikologi)
Humanities (Ilmu Budaya)
Science and Technology (Sains dan Teknologi)
Public Health (Kesehatan Masyarakat)
Nursing (Keperawatan)
Fisheries and Maritime (Perikanan dan Kelautan)
Advanced and Multidisciplinary Technology (Teknologi Maju dan Multidisiplin)
Vocational (Vokasi)
Other:
BBK Internasional Destination
*
Universiti Teknologi Malaysia (UTM), Malaysia
Shizuoka University, Jepang
Are you willing to pay
Rp1.000.000 - Rp25.000.000
for your housing?
This
includes
housing for approximately two weeks (during the whole program period).
The amount stated
excludes
round-trip flight tickets, visa, meals, and accommodation.
*
Yes
No
If you are accepted,
we do not advise
you to withdraw your application from the BBK International program as it will generally effect your BBK Regular application at LPMB (Lembaga Pengembangan Masyarakat Berkelanjutan) Universitas Airlangga.
If you still wish to withdraw
, please inform LPMB Secretariat by
4 December 2025
. Beyond this date, you are fully responsible of the consequences of your BBK Regular application at LPMB Universitas Airlangga.
*
I Understand.
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report