PSP 2018 Application Form Int'l Student
Event Timing: Monday, July 9th – Friday, July 27th 2018
Event Address: Petra Christian University, Address: Siwalankerto 121 - 131 Surabaya 60236 East Java, Indonesia
Contact us at psp.admin@petra.ac.id
Website: http://psp.petra.ac.id/
Email address *
Your Name in Passport *
Your answer
Sex *
City of Birth *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Your Home Address *
Please write your home address, including name of the city, country and postal code
Your answer
Your Hand Phone Number *
Please include your country code & area code number
Your answer
Your LINE ID *
You must install and make LINE ID for PSP group chat.
Your answer
Passport Number *
Your answer
Passport Valid Until *
MM
/
DD
/
YYYY
Your Nationality Based on Passport *
Your answer
Religion *
Your answer
Is there anything you avoid to eat? *
Your answer
Please Describe about Yourself and Personality *
Please tell us in brief about yourself and your personality in order to make other students know you better
Your answer
Name of Your Home University *
Your answer
Name of Your Department at Home University *
Your answer
Your Recent GPA score (...... out of ......) *
Example: 3.5 out of 4 it means your GPA is 3.5 from a possible 4.0 total GPA
Your answer
Your English Language Proficiency *
Poor
Good
Excellent
Reading Skill
Speaking Skill
Listening Skill
Writing Skill
Name of the Person to Notify in Case of Emergency *
Your answer
Relationship to You *
Father or Mother or Sister or Lecturer. Please write down if you have other possibility
Your answer
Phone Number of the Person *
Please include the country code & the area code number
Your answer
I confirm to submit the following supporting documents BEFORE May 31st 2018 *
Required
I confirm to choose one of these programs offered by Petra Summer Program
Please note that the minimum quota of each program is
I declare that I have READ and AGREED to obey the Code of Conduct Form of Petra Christian University, on this this link http://bit.ly/PSP2018InternationalStudentConductDresscode. I declare that all information in my application is correct and true; otherwise, it will be considered ineligible and will disqualify my registration *
A copy of your responses will be emailed to the address you provided.
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