petra christian university jl.siwalankerto 121-131...
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SHORT PROGRAM TO BE ENROLLED AT PETRA CHRISTIAN UNIVERSITY:
Indonesian Language & Culture (ILC)
Indonesian Culinary Art (ICA)
Indonesian Tourism Campaign (ITC)
Urban Indo Art & Design (UIAD)
PETRA CHRISTIAN UNIVERSITYJL.SIWALANKERTO 121-131SURABAYA 60236 EAST JAVAINDONESIATel: +62312983000Fax: +62318492583
Name of Short Program Attended* Special Program for Industrial Challenge and Exposure (SPICE)
Use Your Mouse to Click on Each Box to Fill in Your Data
* Notes:Please put no. 1 and no. 2 on two programs that you are interested in. The numbers will show your choice based on priority.The minimum enrollment quota of each program is 15 students, if the enrollment is below the quota: The under quota program will be cancelled. The student will be automatically moved to his/her second choice.Example:
Special Program for Industrial Challenge and Exposure (SPICE)
2 Indonesian Language & Culture (ILC)
Indonesian Culinary Art (ICA)
1 Indonesian Tourism Campaign (ITC)
choice is Indonesian Language & Culture (ILC). If ITC has less than15 students, it will be cancelled. The student will automatically be moved to the 2 choice, ILC.
choice is Indonesian Tourism Campaign (ITC), the 2
Urban Indo Art & Design (UIAD)
The 1
JULY 18, 2016 – AUGUST 5, 2016Please Type or Write Clearly in CAPITAL LETTERS & Answer All Questions in English
REGISTRATION FORMPETRA SUMMER PROGRAM 2016
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PERSONAL INFORMATION
1. Full Name
2. Sex Male Female
Yes No
(please also mention the area code)(please also mention the area code)
STUDENT’S ACADEMIC INFORMATION
11. Are you a vegetarian?
3. Religion
4. Place / Date of Birth (MM/DD/YYYY)
6. Mailing Address
7. Email address
9. Hobbies and Interest
11. Do you have any allergy to food or other things?
10. Describe about yourself and personality
1. Name of Home Department
2. Student Registration Number
3. Recent GPA
4. English Language Proficiency Reading Poor Good Excellent
Listening Poor Good Excellent
Speaking Poor Good Excellent
Writing Poor Good Excellent
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1. Relationship to applicant Father Mother Other
(please also mention the country & area codes)
2. Full Name
3. Mailing Address
Zip Code
4. Email address
5. Phone number Mobile(please also mention the country & area codes)
EMERGENCY CONTACT
Person to notify in case of emergency (Guardian)
The committee would like to prepare a T-Shirt for all participants. Please give a check (√) for your T-Shirt size.
Male
28 29 30 31 32 33
Female
Width (inch) 18 20 22 24 26 28Length(inch)
Length(inch) 23.5 25 26 27 28 29
XS S M L XL XXL
Width (inch) 18 18 20 22 24 26
S M L XL XXL XXXL
RESOLUTION. The person in the photo should have a neutral expression, be facing straight into thecamera and doesn’t wear glasses or color contact lens.
REQUIRED DOCUMENTS(Please return the list of the documents below with the completed Registration Form)
I certify that all information in my application is correct and true; otherwise, it will be consideredineligible and will disqualify my registration.
Draw your signature on a separate paper, scan and insert it to this page.Put your signature image next to this arrow
Please send your completed SET OF APPLICATION to [email protected]
1. Code of Conduct Form. Please use the provided form.2. Colored photo in JPG file. The photos must be 1800 x 1200 pixels in DIMENSION and 300 dpi in
PETRA SUMMER PROGRAMCODE of CONDUCT
STUDENTS AGREE TO:
1. Attend all classes, field activities and ceremonies on time.
2. Demonstrate mutual respect toward others.
3. Perform cooperative attitude and respect toward Petra Christian University’s
authorities.
4. Respect and value the rules, norms of life, customs, religions and laws applied in the
community as well as in Indonesia.
5. Dress properly according to the culture of Indonesia and the academic context at Petra
Christian University.
6. Be fully responsible for their belongings and the apartment facilities during the program
implementation. All damages, loss and late check out charges will become the sole
responsibility of the students themselves.
7. Equip themselves with proper and adequate insurance that will protect them during
their trip abroad.
8. Put the host institution free of responsibility over the action or decision taken before
and after the program’s schedule, or without the approval of Petra Christian University.
STUDENTS AGREE NOT TO:
1. Use inappropriate language.
2. Attempt any stealing or lying action.
3. Consume and possess any illegal drugs and alcoholic beverages during the program.
4. Possess, handle, transmit, or use as a dangerous weapon any instrument capable of
harming another person.
5. Bring and wear any jewelry or luxurious things to anticipate any social gap threat.
6. Welcome any guest of different sex into their rooms at the hotel due to the social norms
of Indonesia.
7. Engage in any activity that may physically or emotionally bring unpleasant feeling and
abuse other members of the program as well as the social community in Indonesia.
8. Engage in any political activities in Indonesia.
I, HEREBY, DECLARE THAT:
1. I have read all the information above and I agree to ‘Petra Summer Program’ terms,
conditions, laws and regulations indicated in this Code of Conduct form.
2. By signing this form, I hereby accept the PSP’s Code of Conduct and understand that
they shall take effect once this form is being submitted.
3. I hereby authorize PSP to use any pictures or videos that will be taken by PSP authorized
staff during the program for educational purposes and to promote PSP on dedicated
web-sites and academic advertising material.
4. I hereby declare that I am responsible for all information I share in this form.
Applicant’s Name:
Home Institution(please also mention the country):
(please scan the signature):
Date MM/(DD/YYYY):Applicant’s Signature
Petra Summer Program (PSP) 2016 is open to students of Petra Christian University (PCU)!
What is Petra Summer Program (PSP)?PETRA SUMMER PROGRAM (PSP) is an international program held by Petra Christian University that willgive students the chance to broaden their knowledge by learning from the experts in various disciplinesand experience everything through first hand knowledge about Indonesia, its language, culture, tourism,industry, culinary and urban design.
When is PSP 2016?July 18th – August 5th, 2016
How much is the registration fee?Rp 1.000.000/student
Where will PSP be located?The main location of PSP 2016 is Petra Christian University (Surabaya, Indonesia). However, there willalso be on-site visits and field trips that will enable students to get hands-on-experience.
What courses are offered by PSP and how much credit hour (SKS) for each courses?There are 5 courses offered in Petra Summer Program 2016, they are:1. Special Program for Industrial Challenge & Exposure (SPICE) - worth 2 credit hours (SKS)
This program challenges students to become problems solvers in the manufacturing industry forpromoting innovation through industrial business and engineering framework. SPICE is designed forstudents who have background in Engineering and International Business.
2. Indonesian Language & Culture (ILC) – 3 credit hours (SKS)This program helps students to get real experience of learning Indonesian language and culturethrough classes and direct exposure to the life in Indonesia.
3. Indonesian Culinary Art (ICA) – 2 credit hours (SKS)This program introduces the uniqueness of Indonesian culinary to the students. They will learn mainherbs and spices of Indonesian cuisine straight from the traditional market, cook and taste variety oflocal sweets and delicacies.
4. Indonesian Tourism Campaign (ITC) – 3 credit hours (SKS)Students will learn how to design a campaign plan about tourism object in Indonesia. They will havea better understanding of Indonesia, its people, way of life and its unique culture.
5. Urban Indo Art & Design (UIAD) – 3 credit hours (SKS)This program invites students to learn, experience and express artistic creativity and contextualurban design in Indonesia. Students will explore and attend art and design workshop in the villageand city.
What are PSP’s important dates for registration?15 April 2016Deadline for Head of Departments to submit list of student names who will join PSP by filling inNomination Form and send it to [email protected] April 2016Deadline for students to submit their REGISTRATION FORM & all its supporting documents and send it [email protected] May 2016Deadline for paying the program fee Rp 1.000.000,- per student.
Before 1 June 2016All cancellation will incur a cancellation fee Rp 200.000 administration fee. In addition to that,cancellation before 1 June 2016, student will get 70% refund of the program fee.Before 20 June 2016All cancellation will incur a cancellation fee Rp 200.000 administration fee. In addition to that,cancellation before 20 June 2016, student will get 50% refund of the program fee.
What will the student get?1. Academic Transcript & Credit Hour (SKS)2. Program Kits3. Certificate4. Lunch only during the program you have chosen for
What do you have to prepare in order to register yourself?1. Students pick up “Formulir Pendaftaran Program Studi di Luar Negeri” at BAKP, please meet: Ms.
Novielyn or Ms. Renny.2. Students get Head of Department’s approval on the “Formulir Pendaftaran Program Studi di Luar
Negeri” and consult with Head of Department about the possibility of transferring the credit hour(SKS) to their academic transcript.
3. Students submit the “Formulir Pendaftaran Program Studi di Luar Negeri” to BAKP, please meet:Ms. Novielyn or Ms. Renny.
4. Students must be nominated first by their Head of Department before they can fill in theregistration form of PSP 2016. Head of Department can download the NOMINATON FORM from thisemail.
5. Head of Department will send his/her Department’s NOMINATION FORM with the summary of thestudents’ names to [email protected] before or by Friday, 15 April 2016, the latest.
6. After the NOMINATION FORM is submitted by the Head of Department, students can fill inREGISTRATION FORM of PSP and its supporting documents. Student can download theREGISTRATION FORM from this email.NOTE: In order to register, students must fill in. REGISTRATION FORM and choose 2 programs thatthey are interested in and mark their choice number 1 and number 2. The numbers will show yourprogram choice based on priority. The minimum enrollment quota of each program is 15 students, ifthe enrollment is below the quota: The under quota program will be cancelled. The student will be automatically moved to his/her second choice.
7. Students will send their completed REGISTRATION FORM and its supporting documents [email protected] before or by Friday, 29 April 2016, the latest. Please fill in theREGISTRATION FORM carefully.
8. After submitting the REGISTRATION FORM, students can transfer the payment fee Rp 1.000.000.Please see “How can the students pay the payment fee?”
What are qualifications student must pay attention to before registering themselves?1. All courses will be done in English (classes and examination).2. Each course has certain credit hour load. Please check with your Head of Department to find any
possibility of transferring the credit hour of the course you are interested in.3. The MINIMUM ENROLLMENT QUOTA of each program is 15 students, if the enrollment is below the
quota: The under quota program will be cancelled.
The students will be automatically moved to another program based on their program’spreference priority. For more explanation please refer to “What do you have to prepare inorder to register yourself?”
How can the students pay the payment fee?Bank Transfer Payment1. Write this message on your transfer form: PSP2016-PCU-your name-NRP and please transfer the
payment fee toName of Account Holder : Universitas Kristen PetraAccount no. : 033.01.10197.00.3Bank Name : CIMB NiagaBranch : AndayaniSwift Code : BNIAIDJAAddress : Jemur Andayani no. 53A, Surabaya
2. After transferring the payment fee, scan the bank transfer form in color and email it [email protected]. Please include NAME, NRP, DEPARTMENT, EMAIL, HP in the body of youremail.
3. Students will officially be registered in the program once the PSP committees receive theirapplication form and bank receipt.
4. Please note that all bank charges or any bank transfer processing charges will be the responsibilityof the students. In case any bank expenses are charged to Petra Christian University, the studentswill pay the missing amount in cash and it must be done at the PSP committees’ office.
CONTACT:Ms. Novielyn Anthonio & Ms. Renny Novemsy DeseBAKP (Bureau for Cooperation & Institutional Development)Office Location: Entrance Hall (EH) 2nd floorOffice Hour: 09.00 AM – 04.00 PM