Telkom University Short Program

Short Program Choices*
Personal Information
Name (As shown in passport)*
First Last
Gender*
- Male
- Female
Date of birth*
Month
Day
Year
Nationality*
Passport Number*
Passport expiry date*
MM slash DD slash YYYY
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact
Emergency Contact (phone number)*
Emergency Contact (Email)
Relationship to the Emergency Contact*
Academic Information
Academic*
Name of Institution*
Study Program*
Year*
Student ID Number at Home School/University*
Required Documents
Required Document (1. Scan of passport)*
Accepted file types: jpg, png, pdf, Max. file size: 700 MB.
Required Document (2. Photo)*
Accepted file types: jpg, png, Max. file size: 700 MB.
General Information
Payment: We will send you invoice and the payment procedure to your e-mail.

Personal Information