YARSI University Non-Degree program Application Form

Please send the following documents in PDF/PNG to emial: collaboration@yarsi.ac.id

1. Passport-size photos (blue or red background)
2. Scan of a passport (two pages, not taken with a phone camera) or a valid ID card or nationality card
3. Learning Agreement. Downloaded here.
4. An up-to-date certified academic transcript (in English translation)
5. A recommendation letter from the student’s academic advisor or home institution supporting their application.
6. A status letter from the student’s home institution. Downloaded here.

Full Name (as it appears on your passport) *

Citizenship *

Date of birth *

Place of Birth *

City *

Province *

Country *

Postal Code *

Email Address *

Phone Number *

Home Institution/University *

Home Faculty *

Department/Study Program *

Proposed Program (Please Tick One)

• Student Exchange
• Short Course or Certification
• Intership or Fellowship

Proposed Start Date *

Host Faculty & Department/Research Center at YARSI University *

(For example: Faculty of Psychology, Psychometric research center)

Name of the officer in charge at your home university (Office for International Affairs) *

Email (Office for International Affairs of your home university) *

Phone number (Office for International Affairs of your home university) *

Submit