Student Registration Form

Please fill in all the required information below

Registration successful! Thank you for your submission.

Full Name * Full name is required

Student ID (NIM) * Student ID is required

Email Address * Valid email address is required

Faculty/Major * Please select your faculty/major

Date of Birth * Date of birth is required

Gender *

Male Female

Please select your gender

Address * Address is required

Phone Number * Phone number must be at least 10 digits and contain only numbers