PIBBI 75 Registration Form
2 Week Program: January 6th - 17th, 2020
4 Week Program: January 6th - 31st, 2020
6 Week Program: January 6th - February 14th, 2020
or within the duration of January - February 2020

Language Training Center of Satya Wacana Christian University, Salatiga, Central Java
Contact us at +62 (298) 313 859 or ltc@adm.uksw.edu

Please fill out the following form for your registration process to Program Intensif Bahasa dan Budaya Indonesia (PIBBI = Intensive Program of Indonesian Language & Culture)
Email address *
PERSONAL INFO
Please fill out each field for your registration purposes.
Complete Name *
Name you wish to appear in your certificate / diploma & transcript
Your answer
Name you wish to be called during the program
Your answer
Gender *
Nationality *
Your answer
DOB *
Click the icon below
MM
/
DD
/
YYYY
Place of birth *
Your answer
Passport Number *
Your answer
Passport Validation *
Please make sure your current passport has a minimum validation for 6 months.
MM
/
DD
/
YYYY
Profession *
Please choose what you do for a living
If "other", please state below
Your answer
Permanent Address *
Written on your passport / ID
Your answer
Phone Number *
Your answer
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