Assalamualaikum and Salam Sejahtera,

Attention to All Students,

INVITATION: SUMMER PROGRAM UNIVERSITAS PADJADJARAN 2019

Universitas Padadjaran (Unpad), Bandung, Indonesia is inviting students to participate in the

Summer Program Universitas Padjadjaran 2019. The annual 14 days program will be held

on the 11th to 25th of July, 2019. The topic of this program is “Empowering Integrated

Culture and Art for Tourism via Digital Economy 4.0”, in which to be held in Jatinangor,

Pangandaran and Bandung, Indonesia.

This program is opened mainly for undergraduate and Master's degree students who are

interested to learn about culture, tourism and international relation. Those would like to learn

more about Indonesia and how Indonesian entrepreneurs adapt in the digital era are

encouraged to join as well. Thus, students from business studies, communication studies,

international studies, political studies, sociological studies, and other related fields are

welcomed.

An admission fee of 300 USD for international students (270 USD for early bird) is

chargeable and it includes accommodation and meals for 14 days, transportation, and

tickets for tourism sites, Bandung City Tour, health insurance and a Universitas

Padjadjaran’s student kit.

Students who are interested to participate will need to bear the admission fee, return airfare,

personal expenses, etc.

Instead of paying admission fee on your own, 10 scholarships are available through the

proposal writing competition, please visit: http://international.unpad.ac.id/summer-program/

for more information.

Application dateline:

Early bird : 1st of June, 2019

Regular : 30th of June, 2019

Note:

For internal application, please follow these procedures:

1. Fill up form: HEA(A)-04 Mobility Program Application Form.docx

2. Please send the necessary documents not later than June 21st, 2019 to Centre for

International Affairs, UniMAP.

The program brochure and Mobility Program Application Form (CIA) are as attached.

Any inquiry regarding this program can be forwarded to the following email address:

mobility@unimap.edu.my.

Thank you.

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BORANG PERMOHONAN MENGIKUTI PROGRAM MOBILITI / Mobility Programme Application Form

PANDUAN PERMOHONAN/ INSTRUCTIONS

1) Sila lengkapkan borang dan kemukakan kepada Pusat Pengajian/Fakulti/Institut dalam

tempoh tiga(3) bulan sebelum program bermula.

Please fill in the form and submit it to the respective School/Faculty/Institute in 3 months

before the program starts.

2) Sila kemukakan bersama salinan transkrip akademik dan lain-lain dokumen yang berkaitan.

Please attach certified copies of academic transcript or other relevant documents.

A. BUTIRAN PERIBADI/ Personal Details

Nama Penuh/Full Name:

No. KP / IC No. :

Tarikh Lahir/Date of Birth :

Tempat Lahir/Place of Birth : Umur/Age: No. Pasport/Passport No.:

Jantina/

Gender :

Lelaki/Male

Wanita/Female

Taraf

Perkahwinan/

Marital Status:

Bujang/Single

Berkahwin/Married

Bangsa/Race :

Kewarganegaraan/Nationality :

Agama/Religion:

Alamat Tetap/Permanent Address:

Poskod/Postcode :

No. Tel/Phone No.:

Emel/Email:

Waris Terdekat/Next of Kin :

Nama Penuh/Full Name:

Hubungan/Relationship:

Alamat Tetap/ Permanent Address:

Poskod/Postcode :

No. Tel/Phone No.

Rumah/Home:

Pejabat/Office :

Tel. Bimbit/Mobile:

B. BUTIRAN AKADEMIK/ Academic Details

Nama Pusat Pengajian/Fakulti/Institut/ Name of School/Faculty/Institute:

No. Matrik/Matric No:

Nama Program Pengajian / Name of Academic Program:

Semester Pengajian Semasa /Current Semester:

PNGK Terkini/Current CGPA:

Tahun dijangka Bergraduat/Expected year of Graduation:

Nama Penaja (jika ada)/ Name of Sponsor (if any):

Jenis Penajaan/Type of Sponsor:

Gambar (berukuran

pasport)

Recent Photo (Passport Size)

HEA (A) –04

2

Anugerah Akademik yang Diterima (jika ada) / Academic awards obtained (if any):

Bil. Nama Anugerah/Name of Award Penganjur/Organiser Tarikh Diterima/

Date Received

1.

2.

3.

4.

5.

Aktiviti Ko-kurikulum atau Khidmat Masyarakat / Curricular or Social Service Activities:

Bil. Nama Aktiviti/Name of Activity Peringkat Penyertaan/

Level of Partictipation

Tarikh/Tahun

Date/Year

Jawatan

Disandang/

Post Held

1.

2.

3.

4.

5.

C. BUTIRAN PERMOHONAN/ Application Details

Nama Universiti Hos/Institusi Dipohon / Name of University Host/Institution Applied:

Tempoh Program /

Period of Study: 1 Semester

2 Semester

Lain-lain

Nyatakan :

Jangkaan Tarikh Bermula /Commencement Date :

Dari/From : Hingga/To :

Senarai Kursus Yang Ingin Diikuti / List of Courses to be taken :

Kod Kursus/

Code Nama Kursus/Course’s Name Nilai Kredit/Credit

D. PERAKUAN PEMOHON/ Applicant’s Declaration

Saya mengaku semua maklumat yang diberikan adalah tepat dan benar / I hereby declare that all the information

given are true and correct.

Tandatangan/ Tarikh/

Signature : Date :

3

E. ULASAN PENGERUSI RANCANGAN/ Comment from Program Chaiman

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

Tandatangan dan cop/ Tarikh/

Signature and Stamp : Date :

F. PERAKUAN DEKAN/ Verification from The Dean

Disokong/Support Tidak Disokong/Not Support

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

Tandatangan dan cop/ Tarikh/

Signature and Stamp : Date :

G. KELULUSAN TIMBALAN NAIB CANSELOR (A&A)/ Approval from Deputy Vice Chancellor (A&I)

Diluluskan/Approved Tidak Diluluskan/Not Approved

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

Tandatangan dan cop/ Tarikh/

Signature and Stamp : Date :

H. UNTUK KEGUNAAN PTj PENYELARAS

Pegawai dari UniMAP untuk dihubungi oleh UH /Contact Person from UniMAP :

Nama Penuh/Full Name:

Jawatan/Position:

Pusat Tanggungjawab/ School/Office:

No. Tel/Phone No.

1. Rumah/Home :

2. Pejabat/Office :

3. Tel. Bimbit/Mobile : Emel/Email :

Tindakan Selepas Kelulusan /Action Taken after Approval:

Surat Kelulusan Bersyarat kepada Pelajar yang Diluluskan

Conditional Approval Letter to Student

Surat Makluman kepada Pelajar Yang Tidak Diluluskan

Letter informing Student of non-approval of Application

Mengemukakan Permohonan Pelajar yang diluluskan kepada UH (jika penganjur)

Forwarding of Student’s Approved Application to Host University

4

UNTUK DIISI OLEH UNIVERSITI HOS/To be filled by Host University

G. ULASAN DEKAN UNIVERSITI HOS/ Comment from the Dean of Host University

Bersetuju/Agree Tidak Bersetuju/Decline menerima permohonan pelajar ini/this student’s application.

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

Tandatangan dan cop/ Tarikh/

Signature and Stamp : Date :