Language Training Center
SATYA WACANA CHRISTIAN UNIVERSITY
Program Intensif Bahasa & Budaya Indonesia
(PIBBI)
Registration Form
PERSONAL INFO
Full Name as you wish it to appear in your certificate
Name you wish to be called during the program
Gender
Male
Female
Nationality
Date of Birth
Passport Number
Permanent Address
Phone
Mobile
Have you ever been to Indonesia before?
If yes, When?
Email
Yes
No
Where?
For what purpose?
Rate your knowledge about Indonesia
Food
Weather
People
Transport System
Communication System
Money
poor
poor
poor
poor
poor
poor
fair
fair
fair
fair
fair
fair
Are you covered by overseas travel insurance during the program?
good
good
good
good
good
good
Yes
excellent
excellent
excellent
excellent
excellent
excellent
No
EMERGENCY FAMILY CONTACT
Name
Relationship
Address
Phone
Fax
Email
TRAVEL SERVICE
Do you need travel service from the airport to Salatiga?
Yes
No
The Committee provides airport pick-up services from one the three nearby airports one day before the program
date. Please adjust your travel schedule to fit one of the following schedules.
Airport Please choose one
Leave from the airport at Please choose one
YOUR FLIGHT INFO
Airport
Date of flight
Flight number
Arrival time
ACCOMODATION
Do you need LTC’s help for your accommodation?
Yes
No
If, YES, please indicate your type of accommodation for the program: Please choose one
NOTE:
Participants enrolled through ANU will have to pay homestay and meal fees separately as they are not covered in
your tuition fee at ANU.
HOMESTAY INFORMATION
Rp. 600.000 / week included in the program fee except for ANU Students.
Including breakfast & dinner during weekdays, breakfast, lunch & dinner during weekends, and laundry.
Cancelation of the arrangement should be done at least a week prior the date or the payment still remained.
You can arrive at your homestay family one day prior to your program date. Do let us know if you arrive earlier and
require a homestay. We can arrange that with additional fee.
Please complete this part to help us find the best homestay family for you.
What kind of family would you like to be placed with
Married couple with no children
Family with grown-up children
Would you mind living with pets? (i.e. birds, cat?)
Religious preference (optional):
Moslem
Yes
Do you smoke?
Yes
No
Christian
Are you willing to attend religious services with your hosts?
Family with small children
Any
Yes
No
No
If you don’t smoke, would you mind living with a smoking family?
Yes
Would you mind living with other international/Indonesian students in the house?
No
Yes
Any special information/requests that would help us to make the best homestay match possible?
No
GUEST HOUSE INFORMATION
University Guest House ( 1.5 km from Campus) Rp. 112,500/ night
HOTEL INFORMATION
I will make my own reservation
I want LTC to make my hotel reservation:
Hotel choice:
Grand Wahid Hotel ( 1 km from Campus) Rp. 375,000/night
www.hotelwahidsalatiga.com
Le Beringin Hotel ( 2.5 km from Campus) Rp. 236,000/night
www.hotelberingin.com
Laras Asri Hotel ( 3 km from Campus) Rp. 502,000/night
www.larasasriresort.com
Kayu Arum ( 3 km from Campus) Rp. 405,000/night
www.kayuarum.com
Hotel Surya ( 2.5 km from Campus) Rp. 160,000/night
All prices are for standard rooms & breakfast. Please contact LTC for the updated price before you choose
your hotel.
Check-in date:
Check-out date:
MEDICAL & DIET INFORMATION
Specify any allergies you have (eg. Food, pet animals, etc.) that may affect your Homestay and the program
Are you on a diet for medical or religious reasons?
Yes
No
If yes, please describe
Are you a vegetarian?
Yes
No
OTHERS
How would you describe yourself (check all that apply to you)?
Outgoing
Cooperative
Adaptable
Studious
Motivated
Shy
Quiet
Dependable
Other:
Enthusiastic
Personable
Independent
Sensitive
PROGRAM REGISTRATION
Program Enrollment
I am registering for Please choose one
PIBBI offers four selections of programs for two, four, six and seven weeks. Please indicate in which program you
wish to be enrolled.
two-week program (3 – 13 January 2012)
four-week program (3 – 27 January 2012)
six-week program (3 January – 10 February 2012)
seven-week program (3 January – 17 February 2012) ANU Students only
Field Study
Participants enrolled in the four and seven - week programs should write a field study report about Indonesia as
part of the program. To help us find suitable readers for your field study report, please briefly explain what are
your topic or tentative topics?
Indonesian Arts Class
As part of your language learning experience, we are offering Indonesian Arts class that will give you hands-on
experience with various Indonesian arts. We have a selection of four options: Kelas Pencak Silat, Kelas Menari,
Kelas Angklung & Kulintang and Kelas Memasak that you can choose to take for 8 hours in 4 sessions. You will have
to stay in one class for the entire 8 hours and may not move from one class to another. All classes are held at the
same time and therefore you should really decide what you want to do. At the end of the program there will be a
Culture Day where you will perform or show what you have learned in your Indonesian Arts class. Your active
participation in each session will result in a good performance on the culture day.
Please read the Indonesian Art Class Descriptions below before making your choice. Your decision in this form is
not final as you may still move to another class after the program orientation on 2 August 2011. However, since
some classes are only open with a minimum number of students, we need to have some idea as to which classes to
make available.
Kelas Batik:
Batik is a method of dyeing fabric where some areas are covered with wax or pastes made of glues or starches to
make designs by keeping dyes from penetrating in pattern areas. Multicolored and blended effects are obtained by
repeating the dyeing process several times, with the initial pattern of wax boiled off and another design applied
before dyeing again in a new color. Indonesia is famous for its batiks.
(taken from: http://www.equilters.com/library/tips-hows/glossary.html)
Course Objective:
At the end of the course, the participants will be able to produce a piece of Batik cloth
following all the complicated procedures involved in Batik including drawing different
patterns of common Javanese Batik. The final result of the work will be presented in the
Culture Night.
PIBBI rating based on previous PIBBI participants’ experience: ***** (Intricate)
Kelas Pencak Silat:
Pencak Silat is the official name used to indicate more than 800 martial arts schools and styles spread across more
than 13,000 islands in Indonesia. However, this is actually a compound name consisting of two terms used in different
regions. The word "pencak" and its dialectic derivatives such as "penca" West Java and "mancak" (Madura and Bali) is
commonly used in Java, Madura and Bali, whereas the term "silat" or "silek" is used
in Sumatra. The ambition to unify all these different cultural expressions in a
common terminology as part of declaring Indonesia's unity and independence from
colonial power, was first expressed in 1948 with the establishment of the Ikatan
Pencak Silat Indonesia (Indonesian Pencak Silat Association, IPSI). However, it could
only be realized in 1973 when representatives from different schools and styles
finally formally agreed to the use of "pencak silat" in official discourse, albeit
original terms are still widely used at the local level.
(taken from: http://en.wikipedia.org/wiki/Pencak_Silat)
Course Objective:
At the end of the course, the participants will be able to perform several basic
movements in Pencak Silat. Participants from this class will perform Pencak Silat at the Culture Night.
PIBBI rating based on previous participants’ experience: ***** (electrifying)
Kelas Menari:
Indonesian dances (Indonesian: Tarian Indonesia) are the reflection
of the country’s diversity. There are a lot of styles depending on the
ethnicities and cultures behind them. With more than 700 ethnic
groups in Indonesia, you can find anything from the Austronesian
roots to Melanesian tribal forms, with influences ranging from
neighboring Asian and even western styles through colonization.
However, in regards to the more holistic approach, the dances of
Indonesia can be divided into three kinds of stages: Prehistoric Era,
the Era of Hinduism and Buddhism, and the Era of Islam. Moreover,
dances are divided into two: Court Dances and Folk Dances.
(taken from: http://en.wikipedia.org/wiki/Dance_of_Indonesia)
Course Objective:
At the end of the course, the participants will be able to perform one traditional dance complete with the costume.
Participants will perform at the Culture Night.
PIBBI rating based on previous participants’ experience: ***** (mesmerizing)
Kelas Angklung:
Angklung is a musical instrument made out of two bamboo tubes attached
to a bamboo frame. The tubes are carved so that they have a resonant pitch
when struck. The two tubes are tuned to octaves. The base of the frame is
held with one hand while the other hand shakes the instrument rapidly from
side to side. This causes a rapidly repeating note to sound. Thus each of three
or more angklung performers in an ensemble will play just one note and
together complete melodies are produced. Angklung is popular throughout
Southeast Asia, but originated from Indonesia (used and played by the
Sudanese since the ancient times).
(taken from: http://en.wikipedia.org/wiki/Angklung)
Course Objective:
At the end of the course, the participants will be able to perform a mini angklung & kulintang orchestra performance
at the Culture Night.
PIBBI rating based on previous participants’ experience: N/A
Kelas Memasak:
Indonesian cuisine reflects the vast variety of people that live on the 6,000
populated islands that make up Indonesia. Indonesian cuisine is as diverse as
Indonesian culture, and has taken on culinary influences from many sources.
Throughout its history, Indonesia has been involved in trade due to its location
and natural resources. Indonesia’s indigenous techniques and ingredients, at
least in the Malay World parts, are influenced by India, the Middle East, China
and finally Europe. Spanish and Portuguese traders brought New World
produce even before the Dutch came to colonize most of Indonesia. The
Indonesian islands of Maluku are famed as "the Spice Islands" for their introduction of native spices to Indonesian and
global cuisine.
The most popular dishes that originated in Indonesia are common across most of Asia. Popular Indonesian dishes
such as satay, beef rendang, and sambals are also favored in Malaysia and
Singapore. Soy-based dishes, such as variations of tofu (tahu) and tempe, are
also very popular. In fact, tempe is an adaptation of tofu to the tropical
climates of Indonesia. Indonesian meals are commonly eaten with the
combination of spoon in the right hand and fork in the left hand, although in
many parts of the country (such as West Java) it is also common to eat with
one's hands.
(taken from: http://en.wikipedia.org/wiki/Cuisine_of_Indonesia)
Course Objective:
At the end of the course, the participants will be able to cook a variety of Indonesian dishes from various parts of the
country. A sample of the dishes will be presented at the Culture Night.
PIBBI rating based on previous PIBBI participants’ experience: **** (An adventure)
Kelas Gamelan
A gamelan is a kind of musical ensemble of Indonesia typically featuring a variety of
instruments such as metallophones, xylophones, drums, and gongs; bamboo flutes,
bowed and plucked strings, and vocalists may also be included. The term refers
more to the set of instruments than the players of those instruments. A gamelan
as a set of instruments is a distinct entity, built and tuned to stay together —
instruments from different gamelan are not interchangeable. The word
"gamelan" comes from the Javanese word "gamel", meaning to strike or hammer,
and the suffix "an", which makes the root a collective noun.
In Indonesia, gamelan usually accompanies dance, wayang puppet performances,
or rituals or ceremonies. Typically players in the gamelan will be familiar with
dance moves and poetry, while dancers are able to play in the ensemble. In wayang,
the dalang (puppeteer) must have a thorough knowledge of gamelan, as he gives the
cues for the music. Gamelan can be performed by itself - in "klenengan" style, or for
radio broadcasts - but concerts in the Western style are not traditional.
(Taken from: http://en.wikipedia.org/wiki/Gamelan)
Course Objective:
At the end of the course, the participants will be able to perform a mini gamelan orchestra performance at the Culture
Night.
PIBBI rating based on previous PIBBI participants’ experience: ***** (spellbinding)
I will take:
First choice: Kelas Batik
Second choice: Kelas Batik
Third choice: Kelas Batik
Excursion
Excursion is part of the program but not compulsory. To help us finalizing our plan, please indicate your
participation in the excursions. Please read the excursion description (see file: Excursion Description.pdf) with
date and details for your chosen PIBBI program before signing up for the excursion. Should you wish to join us
please adjust your other travel plans accordingly.
Yes, I will join excursion
No, I will not join excursion
Excursion is part of the program but not compulsory. Make sure you are prepared for the excursion including your
insurance.
Expected level: Please choose your level
Have you ever studied Bahasa Indonesia before?
Yes
No
If yes,
When?
For
Where?
academic
For how long?
business
pleasure
Rate your Bahasa Indonesia proficiency
SPEAKING
poor
LISTENING
poor
READING
poor
WRITING
poor
What do you expect to get from the program?
fair
fair
fair
fair
good
good
good
good
excellent
excellent
excellent
excellent
PAYMENT
Registration Status:
NOTES FOR PARTICIPANTS REGISTERED IN ANU’S IN-COUNTRY COURSE:
1. You will still have to pay for your meals and accommodation during the program of ± AU$ 390
2. Payment for accommodation other than homestay should be done directly at the hotel or guesthouse.
LTC can only help with the reservation and by providing UKSW corporate rate for the hotels.
Please indicate your method of payment: Please choose one
I will pay my Please choose one in Please choose one with the total of
For payment in Rupiah, please use the exchange rate from your bank on the date of payment.
Please send us the copy of your payment record from the bank in order to confirm your payment.
Our Bank Account Details:
For payment in Dollars:
BNI Salatiga
Account Name : Satya Wacana Salatiga Indonesia P.I.B.B.I
Bank Address : Jl. Jend. Sudirman Salatiga 50711 Salatiga
Account Number : 0037169045
Switch Code : BNINIDJAXXX
Please earmark as : your name PIBBI
For payment in Rupiah:
Bank CIMB Niaga Salatiga
Account Name : UKSW
Jl. Diponegoro Salatiga 50711 Salatiga
Account Number : 448-01-00099-00-4
Please earmark as : your name PIBBI
Please return the completed form to Language Training Center by email:
RPN Dian Widi Sasanti (Coordinator)
dian.widi@staff.uksw.edu
Student Signature
Date
TYPE YOUR NAME
NO SIGNATURE REQUIRED
YOUR REGISTRATION IS CONFIRMED WITHOUT YOUR SIGNATURE
IF SUBMITTED FROM YOUR EMAIL ADDRESS IN THIS FORM