Indonesia
English
School Information Form
Application for
2025 - 2026
Grade
Grade
Grade 10
Grade 11
Grade 12
Student
Full Name
Place of Birth
Date of Birth
Gender
Male
Female
Nationality
Religion
Islam
Protestan
Katolik
Hindu
Buddha
Khonghucu
Phone Number
Email
Address
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
Sub-district
Urban village
Languages used at Home
Special Needs Children?
Previous School
Previous Grade
Have sibling in Our School ?
Yes
No
Sibling Name
Sibling Grade
Parents (Father)
Father Name
Father Nationality
Phone Number
Father Email
Parents (Mother)
Mother Name
Mother Nationality
Phone Number
Mother Email
Submit
