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Regular S1 Program Registration Form
Gel. 3 - S1 Reguler TA 2026/2027
Campus Location Choice
*
Jakarta
Bekasi
Jakarta Campus option is only for postgraduate programs!
Semester Choice
*
2026/2027 - Odd
Study Program Choice
*
Please select the campus location first
Study Program Choice 1
*
Main Choice
-- Select Study Program --
Teknik Kimia
Teknik Lingkungan
Teknik Industri
Teknik Perminyakan
Informatika
Manajemen
Akuntansi
Ilmu Komunikasi
Psikologi
Ilmu Hukum
Pendidikan Kepelatihan Olahraga
Pendidikan Guru Sekolah Dasar
Study Program Choice 2
* Alternative Choice
-- Select Study Program --
Teknik Kimia
Teknik Lingkungan
Teknik Industri
Teknik Perminyakan
Informatika
Manajemen
Akuntansi
Ilmu Komunikasi
Psikologi
Ilmu Hukum
Pendidikan Kepelatihan Olahraga
Pendidikan Guru Sekolah Dasar
Study Program Choice 3
* Alternative Choice
-- Select Study Program --
Teknik Kimia
Teknik Lingkungan
Teknik Industri
Teknik Perminyakan
Informatika
Manajemen
Akuntansi
Ilmu Komunikasi
Psikologi
Ilmu Hukum
Pendidikan Kepelatihan Olahraga
Pendidikan Guru Sekolah Dasar
Class Choice
*
Please select the first study program choice
A - - : 08.00 - 15.00 WIB
B1 - - : 16.00 - 21.00 WIB
B2 - -: 18.30 - 21.00 WIB : 08.00 WIB -
Citizenship
*
WNI
WNA
Identity Type
*
ID Card
Passport
Family Card
Other ID Number
*
Enter your ID number according to the selected identity type. NIK for Indonesian citizens (KTP & KK) and Passport for foreign citizens
Full Name
*
Write your full name as it appears on your ID card/passport without any title
Gender
*
Male
Female
Place of Birth
*
Enter your place of birth as it appears on your ID card or passport!
Date of Birth
*
Enter your date of birth as it appears on your ID card or passport!
Religion
*
-- Select your religion --
Islam
Kristen Protestan
Katholik
Hindu
Buddha
Konghucu
Lainnya
Mobile Phone Number
*
* Enter your active mobile number. Registration information will be sent to this number. Use the format: 081123456789
Phone Number
*
Use format: 081123456789
Active Email
*
Enter your active email. Payment bills will be sent to this email.
Mother's Name
*
Write your mother's full name without any title
Parent/Guardian's Email
*
Enter your active email. Your parent/guardian's email will be used during your studies at Ubhara Jaya University
Alma Mater Jacket Size
*
-- Pilih Ukuran Jaket --
XXS
XS
S
M
L
XL
XXL
XXXL
>XXXL
Residency Type
*
-- Select your current residency type --
Asrama
Bersama Orang Tua
Kost
Lainnya
Panti Asuhan
Wali
Transportation
*
-- Choose Transportation --
Jalan Kaki
Angkutan Umum/Bus/Pete-pete
Mobil/Bus Antar Jemput
Kereta Api
Ojek
Andong/Bendi/Sado/Dokar/Delman/Becak
Perahu Penyeberangan/Rakit/Getek
Kuda
Sepeda
Sepeda Motor
Mobil Pribadi
Lainnya
Street Name
*
Hamlet Name
*
RT
*
RW
*
Province
*
-- SELECT PROVINCE --
ACEH
BALI
BANTEN
BENGKULU
DI YOGYAKARTA
DKI JAKARTA
GORONTALO
JAMBI
JAWA BARAT
JAWA TENGAH
JAWA TIMUR
KALIMANTAN BARAT
KALIMANTAN SELATAN
KALIMANTAN TENGAH
KALIMANTAN TIMUR
KALIMANTAN UTARA
KEPULAUAN BANGKA BELITUNG
KEPULAUAN RIAU
LAMPUNG
MALUKU
MALUKU UTARA
NUSA TENGGARA BARAT
NUSA TENGGARA TIMUR
PAPUA
PAPUA BARAT
RIAU
SULAWESI BARAT
SULAWESI SELATAN
SULAWESI TENGAH
SULAWESI TENGGARA
SULAWESI UTARA
SUMATERA BARAT
SUMATERA SELATAN
SUMATERA UTARA
Regency/City
*
-- SELECT REGENCY/CITY --
District
*
-- SELECT DISTRICT --
Village
*
-- SELECT VILLAGE --
Postal Code
*
KPS Recipient
*
Bukan Penerima KPS
Penerima KPS
NPWP
*
Leave blank if you don't have an NPWP
National Student Identification Number (NISN)
*
School Major
*
Jurusan IPA
Jurusan IPS
Jurusan Bahasa
Jurusan Keagamaan
Kelompok SMK/MAK
Paket C
Average score of Senior High School semester 4
*
Average score of Senior High School semester 4 report, use a decimal point (e.g., 80.50), for students from package C enter a hyphen ' - '
Average score of Senior High School semester 5
*
Average score of Senior High School semester 5 report, use a decimal point (e.g., 80.50), for students from package C enter a hyphen ' - '
Average SKL score
*
Average SKL score, use a decimal point (e.g., 80.50), for students who do not have SKL enter a hyphen ' - '
Average score of diploma/transcript
*
Average score of diploma/transcript for Package C students, use a decimal point (e.g., 80.50), for students who do not have a transcript enter a hyphen ' - '
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