Semesta 3 Online Application Form
Applying for Academic Year:
*
Mendaftar untuk tahun ajaran:
2023/2024
2024/2025
2025/2026
Applying for Grade:
*
Mendaftar untuk kelas:
PG
KG.A
KG.B
G.7
G.8
G.9
Student's Information
Student's Name
*
Nama Siswa
Nationality
*
Kewarganegaraan
Afghan
Albanian
Algerian
American
Andorran
Angolan
Anguillan
Citizen of Antigua and Barbuda
Argentine
Armenian
Australian
Austrian
Azerbaijani
Bahamian
Bahraini
Bangladeshi
Barbadian
Belarusian
Belgian
Belizean
Beninese
Bermudian
Bhutanese
Bolivian
Citizen of Bosnia and Herzegovina
Botswanan
Brazilian
British
British Virgin Islander
Bruneian
Bulgarian
Burkinan
Burmese
Burundian
Cambodian
Cameroonian
Canadian
Cape Verdean
Cayman Islander
Central African
Chadian
Chilean
Chinese
Colombian
Comoran
Congolese (Congo)
Congolese (DRC)
Cook Islander
Costa Rican
Croatian
Cuban
Cymraes
Cymro
Cypriot
Czech
Danish
Djiboutian
Dominican
Citizen of the Dominican Republic
Dutch
East Timorese
Ecuadorean
Egyptian
Emirati
English
Equatorial Guinean
Eritrean
Estonian
Ethiopian
Faroese
Fijian
Filipino
Finnish
French
Gabonese
Gambian
Georgian
German
Ghanaian
Gibraltarian
Greek
Greenlandic
Grenadian
Guamanian
Guatemalan
Citizen of Guinea-Bissau
Guinean
Guyanese
Haitian
Honduran
Hong Konger
Hungarian
Icelandic
Indian
Indonesian
Iranian
Iraqi
Irish
Israeli
Italian
Ivorian
Jamaican
Japanese
Jordanian
Kazakh
Kenyan
Kittitian
Citizen of Kiribati
Kosovan
Kuwaiti
Kyrgyz
Lao
Latvian
Lebanese
Liberian
Libyan
Liechtenstein citizen
Lithuanian
Luxembourger
Macanese
Macedonian
Malagasy
Malawian
Malaysian
Maldivian
Malian
Maltese
Marshallese
Martiniquais
Mauritanian
Mauritian
Mexican
Micronesian
Moldovan
Monegasque
Mongolian
Montenegrin
Montserratian
Moroccan
Mosotho
Mozambican
Namibian
Nauruan
Nepalese
New Zealander
Nicaraguan
Nigerian
Nigerien
Niuean
North Korean
Northern Irish
Norwegian
Omani
Pakistani
Palauan
Palestinian
Panamanian
Papua New Guinean
Paraguayan
Peruvian
Pitcairn Islander
Polish
Portuguese
Prydeinig
Puerto Rican
Qatari
Romanian
Russian
Rwandan
Salvadorean
Sammarinese
Samoan
Sao Tomean
Saudi Arabian
Scottish
Senegalese
Serbian
Citizen of Seychelles
Sierra Leonean
Singaporean
Slovak
Slovenian
Solomon Islander
Somali
South African
South Korean
South Sudanese
Spanish
Sri Lankan
St Helenian
St Lucian
Stateless
Sudanese
Surinamese
Swazi
Swedish
Swiss
Syrian
Taiwanese
Tajik
Tanzanian
Thai
Togolese
Tongan
Trinidadian
Tristanian
Tunisian
Turkish
Turkmen
Turks and Caicos Islander
Tuvaluan
Ugandan
Ukrainian
Uruguayan
Uzbek
Vatican citizen
Citizen of Vanuatu
Venezuelan
Vietnamese
Vincentian
Wallisian
Welsh
Yemeni
Zambian
Zimbabwean
NISN
Nomor Induk Siswa Nasional
Email
Surel Siswa
Gender
*
Jenis Kelamin
Male
Female
Religion
*
Agama
Islam
Protestantism
Catholicism
Hinduism
Buddhism
Confucianism
Other
Place of Birth
*
Tempat Lahir
Date of Birth
*
Tanggal Lahir
Weight
Berat Badan (Kg)
Height
Tinggi Badan (cm)
Blood Type
Golongan Darah
Health Issues
(if any)
Masalah Kesehatan
Sibling Order
*
Anak ke-
Number of Siblings
*
Jumlah Saudara (tidak termasuk Siswa)
Who do the student live with?
*
Siswa tinggal dengan siapa?
Father
Mother
Both Parents
Guardian
Address
Alamat
Located in Indonesia
Street Address
*
Alamat Jalan
City
*
Kota
Province/State
*
Provinsi/Neg. Bagian
Aceh
Bali
Banten
Bengkulu
D.I. Yogyakarta
D.K.I. Jakarta
Gorontalo
Jambi
Jawa Barat
Jawa Tengah
Jawa Timur
Kalimantan Barat
Kalimantan Selatan
Kalimantan Tengah
Kalimantan Timur
Kalimantan Utara
Kepulauan Bangka Belitung
Kepulauan Riau
Lampung
Maluku
Maluku Utara
Nusa Tenggara Barat
Nusa Tenggara Timur
Papua
Papua Barat
Riau
Sumatera Barat
Sumatera Selatan
Sumatera Utara
Sulawesi Barat
Sulawesi Selatan
Sulawesi Tengah
Sulawesi Tenggara
Sulawesi Utara
Luar Negeri
Others
Country
*
Negara
Postal Code
Kode Pos
Education's Information
Current School's Name
*
Nama Sekolah Sekarang
School's Street Address
*
Alamat Jalan Sekolah
Current Grade
*
Kelas Sekarang
PG
KG.A
KG.B
G.1
G.2
G.3
G.4
G.5
G.6
G.7
G.8
G.9
G.10
G.11
G.12
School Address
Alamat Sekolah
Located in Indonesia
School's City
*
Kota
School's Province/State
Provinsi/Neg. Bagian
Aceh
Bali
Banten
Bengkulu
D.I. Yogyakarta
D.K.I. Jakarta
Gorontalo
Jambi
Jawa Barat
Jawa Tengah
Jawa Timur
Kalimantan Barat
Kalimantan Selatan
Kalimantan Tengah
Kalimantan Timur
Kalimantan Utara
Kepulauan Bangka Belitung
Kepulauan Riau
Lampung
Maluku
Maluku Utara
Nusa Tenggara Barat
Nusa Tenggara Timur
Papua
Papua Barat
Riau
Sumatera Barat
Sumatera Selatan
Sumatera Utara
Sulawesi Barat
Sulawesi Selatan
Sulawesi Tengah
Sulawesi Tenggara
Sulawesi Utara
Luar Negeri
Others
School's Country
*
Negara
School's Postal Code
Kode Pos Sekolah
Parent/Guardian's Information
Father's Name
*
Nama Ayah Siswa
Father's Date of Birth
Tanggal Lahir Ayah Siswa
Father's Nationality
*
Kewarganegaraan Ayah
Afghan
Albanian
Algerian
American
Andorran
Angolan
Anguillan
Citizen of Antigua and Barbuda
Argentine
Armenian
Australian
Austrian
Azerbaijani
Bahamian
Bahraini
Bangladeshi
Barbadian
Belarusian
Belgian
Belizean
Beninese
Bermudian
Bhutanese
Bolivian
Citizen of Bosnia and Herzegovina
Botswanan
Brazilian
British
British Virgin Islander
Bruneian
Bulgarian
Burkinan
Burmese
Burundian
Cambodian
Cameroonian
Canadian
Cape Verdean
Cayman Islander
Central African
Chadian
Chilean
Chinese
Colombian
Comoran
Congolese (Congo)
Congolese (DRC)
Cook Islander
Costa Rican
Croatian
Cuban
Cymraes
Cymro
Cypriot
Czech
Danish
Djiboutian
Dominican
Citizen of the Dominican Republic
Dutch
East Timorese
Ecuadorean
Egyptian
Emirati
English
Equatorial Guinean
Eritrean
Estonian
Ethiopian
Faroese
Fijian
Filipino
Finnish
French
Gabonese
Gambian
Georgian
German
Ghanaian
Gibraltarian
Greek
Greenlandic
Grenadian
Guamanian
Guatemalan
Citizen of Guinea-Bissau
Guinean
Guyanese
Haitian
Honduran
Hong Konger
Hungarian
Icelandic
Indian
Indonesian
Iranian
Iraqi
Irish
Israeli
Italian
Ivorian
Jamaican
Japanese
Jordanian
Kazakh
Kenyan
Kittitian
Citizen of Kiribati
Kosovan
Kuwaiti
Kyrgyz
Lao
Latvian
Lebanese
Liberian
Libyan
Liechtenstein citizen
Lithuanian
Luxembourger
Macanese
Macedonian
Malagasy
Malawian
Malaysian
Maldivian
Malian
Maltese
Marshallese
Martiniquais
Mauritanian
Mauritian
Mexican
Micronesian
Moldovan
Monegasque
Mongolian
Montenegrin
Montserratian
Moroccan
Mosotho
Mozambican
Namibian
Nauruan
Nepalese
New Zealander
Nicaraguan
Nigerian
Nigerien
Niuean
North Korean
Northern Irish
Norwegian
Omani
Pakistani
Palauan
Palestinian
Panamanian
Papua New Guinean
Paraguayan
Peruvian
Pitcairn Islander
Polish
Portuguese
Prydeinig
Puerto Rican
Qatari
Romanian
Russian
Rwandan
Salvadorean
Sammarinese
Samoan
Sao Tomean
Saudi Arabian
Scottish
Senegalese
Serbian
Citizen of Seychelles
Sierra Leonean
Singaporean
Slovak
Slovenian
Solomon Islander
Somali
South African
South Korean
South Sudanese
Spanish
Sri Lankan
St Helenian
St Lucian
Stateless
Sudanese
Surinamese
Swazi
Swedish
Swiss
Syrian
Taiwanese
Tajik
Tanzanian
Thai
Togolese
Tongan
Trinidadian
Tristanian
Tunisian
Turkish
Turkmen
Turks and Caicos Islander
Tuvaluan
Ugandan
Ukrainian
Uruguayan
Uzbek
Vatican citizen
Citizen of Vanuatu
Venezuelan
Vietnamese
Vincentian
Wallisian
Welsh
Yemeni
Zambian
Zimbabwean
Father's Email
*
Surel Ayah Siswa
Father's Phone Number
*
No. Telp Ayah Siswa
Father's WhatsApp Number
No. WhatsApp Ayah Siswa
Same with Phone Number
Father's Education Background
Pendidikan Terakhir Ayah Siswa
Father's Occupation
*
Pekerjaan Ayah Siswa
Father's Company or Institution
Perusahaan atau Institusi Ayah Siswa
Father's Position in Company
Jabatan Ayah Siswa
Father's Salary
*
Gaji Ayah Siswa
< 10.000.000
10.000.000-25.000.000
25.000.000-35.000.000
35.000.000-50.000.000
> 50.000.000
Father's Office Address
Alamat Kantor Ayah Siswa
Father's Office Phone
No. Telp Kantor Ayah Siswa
Family Card/ITAS/SKTT
No. Kartu Keluarga/ITAS/SKTT
Mother's Name
*
Nama Ibu Siswa
Mother's Date of Birth
Tanggal Lahir Ibu Siswa
Mother's Nationality
*
Kewarganegaraan Ibu
Afghan
Albanian
Algerian
American
Andorran
Angolan
Anguillan
Citizen of Antigua and Barbuda
Argentine
Armenian
Australian
Austrian
Azerbaijani
Bahamian
Bahraini
Bangladeshi
Barbadian
Belarusian
Belgian
Belizean
Beninese
Bermudian
Bhutanese
Bolivian
Citizen of Bosnia and Herzegovina
Botswanan
Brazilian
British
British Virgin Islander
Bruneian
Bulgarian
Burkinan
Burmese
Burundian
Cambodian
Cameroonian
Canadian
Cape Verdean
Cayman Islander
Central African
Chadian
Chilean
Chinese
Colombian
Comoran
Congolese (Congo)
Congolese (DRC)
Cook Islander
Costa Rican
Croatian
Cuban
Cymraes
Cymro
Cypriot
Czech
Danish
Djiboutian
Dominican
Citizen of the Dominican Republic
Dutch
East Timorese
Ecuadorean
Egyptian
Emirati
English
Equatorial Guinean
Eritrean
Estonian
Ethiopian
Faroese
Fijian
Filipino
Finnish
French
Gabonese
Gambian
Georgian
German
Ghanaian
Gibraltarian
Greek
Greenlandic
Grenadian
Guamanian
Guatemalan
Citizen of Guinea-Bissau
Guinean
Guyanese
Haitian
Honduran
Hong Konger
Hungarian
Icelandic
Indian
Indonesian
Iranian
Iraqi
Irish
Israeli
Italian
Ivorian
Jamaican
Japanese
Jordanian
Kazakh
Kenyan
Kittitian
Citizen of Kiribati
Kosovan
Kuwaiti
Kyrgyz
Lao
Latvian
Lebanese
Liberian
Libyan
Liechtenstein citizen
Lithuanian
Luxembourger
Macanese
Macedonian
Malagasy
Malawian
Malaysian
Maldivian
Malian
Maltese
Marshallese
Martiniquais
Mauritanian
Mauritian
Mexican
Micronesian
Moldovan
Monegasque
Mongolian
Montenegrin
Montserratian
Moroccan
Mosotho
Mozambican
Namibian
Nauruan
Nepalese
New Zealander
Nicaraguan
Nigerian
Nigerien
Niuean
North Korean
Northern Irish
Norwegian
Omani
Pakistani
Palauan
Palestinian
Panamanian
Papua New Guinean
Paraguayan
Peruvian
Pitcairn Islander
Polish
Portuguese
Prydeinig
Puerto Rican
Qatari
Romanian
Russian
Rwandan
Salvadorean
Sammarinese
Samoan
Sao Tomean
Saudi Arabian
Scottish
Senegalese
Serbian
Citizen of Seychelles
Sierra Leonean
Singaporean
Slovak
Slovenian
Solomon Islander
Somali
South African
South Korean
South Sudanese
Spanish
Sri Lankan
St Helenian
St Lucian
Stateless
Sudanese
Surinamese
Swazi
Swedish
Swiss
Syrian
Taiwanese
Tajik
Tanzanian
Thai
Togolese
Tongan
Trinidadian
Tristanian
Tunisian
Turkish
Turkmen
Turks and Caicos Islander
Tuvaluan
Ugandan
Ukrainian
Uruguayan
Uzbek
Vatican citizen
Citizen of Vanuatu
Venezuelan
Vietnamese
Vincentian
Wallisian
Welsh
Yemeni
Zambian
Zimbabwean
Mother's Email
*
Surel Ibu Siswa
Mother's Phone Number
*
No. Telp Ibu Siswa
Mother's WhatsApp Number
No. WhatsApp Ibu Siswa
Same with Phone Number
Mother's Education Background
Pendidikan Terakhir Ibu Siswa
Mother's Occupation
Pekerjaan Ibu Siswa
Mother's Company or Institution
Perusahaan atau Institusi Ibu Siswa
Mother's Position in Company
Jabatan Ibu Siswa
Mother's Salary
Gaji Ibu Siswa
< 10.000.000
10.000.000-25.000.000
25.000.000-35.000.000
35.000.000-50.000.000
> 50.000.000
Mother's Office Address
Alamat Kantor Ibu Siswa
Mother's Office Phone
No. Telp Kantor Ibu Siswa
Documents
Kartu Keluarga
*
Bisa dalam bentuk foto
Maks. 5 MB
KTP Ayah
*
Bisa dalam bentuk Foto
Maks. 5 MB
KTP Ibu
*
Bisa dalam bentuk foto
Maks. 5 MB
Kartu Imunisasi
*
Bisa dalam bentuk foto
Maks. 5 MB
Ijazah
Bagi pindahan
Maks. 5 MB
Rapor kelas 5 / Rapor terakhir
Bisa dalam bentuk foto
Maks. 5 MB
Surat Rekomendasi psikolog
Bagi siswa yang belum cukup usia
Maks. 5 MB
Akte Kelahiran
*
Bisa dalam bentuk foto
Maks. 5 MB
Additional Information
Does the student have sibling(s) studying in Semesta 3?
*
Apakah mempunyai saudara di sekolah?
Yes
Yes, Alumni
No
Nama saudara yang ada di sekolah
(Jika lebih dari satu, pisahkan dengan koma)
Is the student going to stay in the school dormitory?
*
Apakah siswa akan tinggal di asrama sekolah?
Yes
No
How did you get information about Semesta 3?
*
Bagaimana mendapatkan informasi mengenai Semesta 3?
Ads
Brochure
Current Student
Family
Friend
Invitation
News
Social Media
Website
Others
Submit Application