Program PenerimaanAdmission Program *
Reguler
Reguler
Mahasiswa Asing
Profesi
Rekognisi Pembelajaran Lampau
Pasca Sarjana
COMMUNITY BASED LEARNING
Jenis Program Program Type *
NON KEDOKTERAN (NON MEDICAL)
NON KEDOKTERAN (NON MEDICAL)
KEDOKTERAN (MEDICAL)
Kelas Program *
Pagi
Pagi
Sore
Skema Penerimaan Admission Scheme *
Beasiswa
Prestasi
Umum
Beasiswa
Kemitraan
Sub Skema Penerimaan Admission Sub Scheme *
Beasiswa Bidikmisi Skema B
Beasiswa KIP
Beasiswa Bidikmisi Skema B
Beasiswa Bidikmisi Skema C
Beasiswa Bidikmisi Skema A
Program Studi PilihanStudy Program *
Prodi S1 Keperawatan
Prodi S1 Keperawatan
Prodi D-III Keperawatan
Prodi S1 Kebidanan
Prodi S1 Kesehatan Masyarakat
Prodi D-IV Analis Kesehatan
Prodi S1 Gizi
Prodi D-IV Keselamatan dan Kesehatan Kerja
Prodi S1 Akuntansi
Prodi S1 Manajemen
Prodi S1 Pendidikan Guru PAUD
Prodi S1 Pendidikan Guru SD
Prodi S1 Pendidikan Bahasa Inggris
Prodi S1 Sistem Informasi
Nama Lengkap Full Name
Jenis Kelamin Gender *
Laki-Laki
Perempuan
Tempat Lahir Place of Birth *
<-- Harus sesuai dengan Ijazah terakhir
Tanggal Lahir* Date of Birth
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Januari
Pebruari
Maret
April
Mei
Juni
Juli
Agustus
September
Oktober
Nopember
Desember
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
Kewarganegaraan Citizenship *
Warga Negara Asing
Warga Negara Indonesia
Pilih Warga Negara
-- Pilih Negara --
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Saint Eustatius and Saba
Bosnia And Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic Of The
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island And Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Iran, Islamic Republic Of
Iraq
Ireland
Isle Of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People'S Republic Of
Korea, Republic Of
Kuwait
Kyrgyzstan
Lao People'S Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, The Former Yugoslav Republic Of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States Of
Moldova, Republic Of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Bartelemey
Saint Helena
Saint Kitts And Nevis
Saint Lucia
Saint Martin
Saint Pierre And Miquelon
Saint Vincent And The Grenadines
Samoa
San Marino
Sao Tome And Principe
Saudi Arabia
Senegal
Serbia
Serbia And Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia And The South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard And Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province Of China
Tajikistan
Tanzania, United Republic Of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis And Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
No. HP Reguler Handphone Number
No. WhatsApp Whatsapp Number *
Email Email *
NPSN Sekolah Asal NPSN or School Name
Jurusan Asal Major in High School
Tahun Lulus Year Of Graduation
Perguruan Tinggi Asal Latest University
Prodi/Jurusan Asal Latest Study Program
Tahun Lulus Graduation Year
Kota Ujian City for Exam *
KOTA SURABAYA
Jam Ujian Exam Time *
Kode Konfirmasi Chaptcha
7 + 9 =
