Student Registration Form

Please fill out the form accurately to complete your registration.

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Full Name

Full Name is required.

Student ID (NIM)

Student ID is required.

Email Address

A valid Email Address is required.

Faculty/Major

Faculty/Major selection is required.

Date of Birth

Date of Birth is required.

Gender

Male Female

Gender selection is required.

Address

Address is required.

Phone Number

Phone Number must be numeric and at least 10 digits long.