Indonesia
English
Admission Form
Application for
2025 - 2026
2024 - 2025
Grade
Grade 7
Grade 8
Grade 9
Student
Full name
Place of Birth
Date of Birth
Gender
Male
Female
Nationality
Religion
Islam
Protestan
Katolik
Hindu
Buddha
Khonghucu
Phone Number (if any)
Email (if any)
Address
Province
-- Select Province --
KALIMANTAN UTARA
KALIMANTAN TIMUR
KALIMANTAN SELATAN
BALI
NUSA TENGGARA BARAT
NUSA TENGGARA TIMUR
SULAWESI UTARA
SULAWESI TENGAH
SULAWESI SELATAN
SULAWESI TENGGARA
SULAWESI BARAT
GORONTALO
MALUKU
MALUKU UTARA
PAPUA BARAT
PAPUA
SUMATERA UTARA
SUMATERA BARAT
RIAU
JAMBI
SUMATERA SELATAN
BENGKULU
LAMPUNG
KEPULAUAN BANGKA BELITUNG
KEPULAUAN RIAU
DKI JAKARTA
JAWA BARAT
JAWA TENGAH
DI YOGYAKARTA
JAWA TIMUR
BANTEN
KALIMANTAN BARAT
KALIMANTAN TENGAH
ACEH
District
-- Select Disctrict --
Sub-district
-- Select Sub-district --
Urban village
-- Select Village --
Languages used at Home
Special Needs Children?
Previous School
Previous Grade
Have sibling in Regents School ?
Yes
No
Sibling Name
Sibling Grade
Parents
Father
Full name
Nationality
Phone Number
Email
Mother
Full name
Nationality
Phone Number
Email
Emergency Contact
Submit
