Online Registration

Please fill in the form below as much as possible.
You must be at least 15 years old to register.

Note: * = Required

* Program you are interested in

* Registration Classification

Personal Information

Name should be same as your passport, NOT ABBREVIATED and WITHOUT EDUCATIONAL DEGREE.

* Full Name

* Birth Place

* Birth Date

* Sex

* Religion

* Citizenship

Phone (with regional code)

* HP (Whatsapp)

Passport No.

NISN

Blood Type

Residence in Jakarta

* Child to * from siblings

* Marital Status

Fill in your e-mail below, then click Send E-mail Verification Code so that the verification code is sent to your e-mail.

Next, open your e-mail and enter the verification code that has been sent in the E-mail Verification Code field below.

Be sure to check your SPAM folder if the e-mail has not been received.

* E-mail

Send E-mail Verification Code

E-mail Verification Code

Home number, RT/RW, post code and region should be typed in the appropriate fields (do not include it in the Address field).

* Address

RT/RW /

Propinsi

Kab./Kota

Kecamatan

Kel./Desa

Post Code

Family Information

Father's and mother's name should be typed WITHOUT TITLE and NOT ABBREVIATED.

* Father's Name

Father's Birth Place

Father Circumstance

Father's Birth Date

Father's ID Card No.

Father's Education

Father's Job

Father's Income

* Mother's Name

Mother's Birth Place

Mother Circumstance

Mother's Birth Date

Mother's ID Card No.

Mother's Education

Mother's Job

Mother's Income

Phone (with regional code)

Parent HP

Parent E-mail

Tanggungan Orang Tua persons

Home number, RT/RW, post code and region should be typed in the appropriate fields (do not include it in the Address field).

* Parent Address

RT/RW /

Propinsi

Kab./Kota

Kecamatan

Kel./Desa

Post Code

Others

Info about IPT #1

Info about IPT #2

Info about IPT #3

IP Trisakti Priority

Jacket Size

Panduan ukuran jaket

Referral Name

Referral Phone

Referral HP

Recommendation Origin