KEMENTERIAN PENDIDIKAN, KEBUDAYAAN,

RISET, DAN TEKNOLOGI

T]NIVERSITAS STJMATERA TITARA
Jalan Dr. T. Mansur Nomor 9 Kampus USU Medan 20155
Telepon (061) 821 1633, 8216575, Faximile (061) 821941 1, 8211822,8211766
Laman www.usu.ac.id

Nomor : 80l0AlN5. l.R I lSPBl2Oz4

Lampiran : I Berkas
Perihal : Rekomendasi dan pemyataan komifinen mendukung Program IISMA 2024

Yth.
Direktur Jenderal Pendidikan Tinggi
Kementerian Pendidikaq Kebudayaan, Riset, dan Teknologi
Republik Indonesia

Dengan hormat,
Terkait dengan pendaftaran mahasiswa kami pada Program IISMA 2024 yang terlampir di bawah
ini, saya yang bertanda tangan dibawah ini,

Nama : Dr. Edy Ikhsan SH., MA

Nomor lnduk Pegawai : 196302161988031002
Jabatan . Wakil Rektor Bidang Akademik, Kemahasiswaan, dan
Kealumnian Universitas Sumatera Utara

menyatakan komitrnen dan kesanggupan untuk mendukung dan mensukseskan Program lrulonesian
International Student Mobility Awards (IISMA) 2024, termasuk namun tidak terbatas pada hal-hal
sebagai berikut:
l. Menjamin bahwa mahasiswa tersebut berada pada semester 4 atau 6 sejak proses
pendaftaran hingga pengumtman awardee IISMA 2024;
2. Menjamin bahwa mahasiswa tersebut tidak akan mengikuti program II.fBKM (/lagship) lain
di waktu yang bersamaan dengan pelaksanaan Program IISMA 2024 serta tidak pemah
mengikuti program lfrKM (llagship) Kemendikbudristek lebih dari I kali;
3. Menjamin bahwa mahasiswa tersebut merupakan Warga Negara lndonesia dan tidak
berkewarganegaraan ganda;
4. Memberikan rekomendasi bagi mahasiswa tersebut untuk mengikuti Program IISMA 2024
dengan pilihan perguruan tinggi di luar negeri yang tertulis di dalam lampiran;
5. Mengakui mata kuliah beserta kodenya yang diperoleh mahasiswa tersebut dari perguman
tinggi luar negeri mitra Program IISMA 2024, dan memberikan kredit setara 20 SKS, sesuai
ketentuan Keputusan Menteri Pendidikan, Kebudalaarl Riset, dan Telmologi Republik
Indonesia Nomor 210/IW2023 tentang Indikator Kine{a Utama Perguruan Tinggi dan
Lembaga Layanan Pendidikan Tinggi di Kementerian Pendidikan, Kebudayaan, Riset, dan
Teknologi;
6. Menugaskan penanggung jawab dan menyediakan layanan untuk mendukung Program
IISMA 2024 berupa:
a. Pendampingan mahasiswa tersebut sebelum dan sesudah keberangkatan serta
melakukan monitoring dan evaluasi di intemal p€rguruan tinggi;
b. Penugasan koordinator untuk bertindak sebagai penanggung jawab dalam proses
administrasi dan perkuliahan mahasiswa tersebu!
7. Mengikuti ketentuan Program IISMA 2024 dan mendukung suksesnya pelaksanaan
Program Kamprrs Merdeka;
8. Menjamin mahasiswa tersebut tidak mengambil mata k-uliah di Universilas Sumatera Utara
selama mengikuti Program IISMA 2024;
 KEMENTERIAN PENDIDTKAN, KEBUDAYAAN,
RISET, DAN TEKNOLOGI
I ]NIVERSITAS SI IMATERA TITARA
Jalan Dr. T. Mansur Nomor 9 Kampus USU Medan 20155
Telepon (06 1 ) 82 1 1 633, 821 657 5, Faximile (06 1 ) 821941 1, 821 1822, 821 17 66
Laman www.usu.ac.id

9. Memastikan mahasiswa tersebut menaati peraturan yang berlaku di Indonesia maupun di

negara domisili kampus tujuan Program IISMA 2024;
10. Dalam hal terjadinya pembatalan kepesertaan mahasiswa tersebut dalam Program IISMA
2024, maka Universitas Sumatera Utara akan melakukan upaya maksimal untuk
mengembalikan dana yang telah diterima oleh mahasiswa tersebut yang bersangkutan
kepada negara.

Demikian surat pernyataan ini dibuat untuk dapat dipergunakan sebagaimana mestinya

Medarl 2l Februari 2024

Wakil Rektor Bidang Akademik,
waan dan Kealumnian

L
13

SH., MA
198803 I 002
 KEMENTERIAN PENDIDIKAN, KEB UDAYAAN,RISET, DAN TEKNOLOGI
TINIVERSITAS SUMATERA TITARA
Jalan Dr, T, Mansur Nomor 9 Kampus USU Medan 20155
Telepon (06 I ) 82 I 1633, 821657 5, Faximile (06 I ) 82 I 94 I 1, 821 I 822, 821 l7 66
Laman www.usu.ac.id

Lampiran : 1 Berkas
Nomor : 8010/UN5. l.Rl
lSPBl2024
Tanggal :21 Februari 2024

Daftar Mahasiswa Calon Peserta Program IISMA Sarjana 2024

No Nama Mahasiswa Perguruan Tinggi Luar Negeri Tuj uan Negara Tujuan
L Hanyang University 1. South Korea
I Agnes Velina Marpaung 2. University of Padua 2. ltaly
3. Universiti Malaya 3. Malaysia
L Technische Universitat Dresden 1. Germany
) Ahmad Yani 2, KTH Royal Institute ofTechnology 2. Sweden
3. Universite Caen Nonnandie 3. France
L National Tairvan University of Science and Technology (Taiwan
Tech) I Taiwan
3 Aisah Fahrani 2. National Taiwan University 2 Taiwan
3. University of Limerick 3. Ireland
I. Universite de Caen Nonnandie I . France
4 Aliyah Fitri Hasibuan 2. Middle East Technical University 2. Turkey
3. University of Szeged 3. Hungary
1 Universite de Caen Normandie
. L France
2. Vytautas Magnus University 2. Ltthuania
5 Aurelia Priscilia Simamora
3. Information Technologies, Mechanics and Optics (ITMO)
University 3. Russia
1 . Osaka University 1 . Japan
6 Betania Syaloomita Nissi H 2. Yale University 2. USA
3. Comell University 3. USA
 KEMENTERIAN PENDIDTKAN, KEBUDAYAAN,RISET, DAN TEKNOLOGI
LINIVERSITAS SUMATERA UTAR{
Jalan Dr. T. Mansur Nomor 9 Kampus USU Medan 20155
Telepon (06 1 ) 82 1 1 633, 82 1 657 5, Faximile (06 1 ) 8219 41 1, 821 1 822, 821 17 66
Laman www.usu.ac.id

1. The Universi of Waikato new Zealand 1 . New Zealand

7 Brigitte Natiar Sitanggang 2. Georgetown University 2. USA
3. Universite de Caen Normandie 3. France
[. Monash University 1 . Australia
2. National Taiwan University ofScience and Technology (Taiwan
tt Calvan
Tech) 2. Taiwan
3. Keio University 3. Jepang
1. University of Szeged I. Hungary
9 Carissa Margaret Sijabat 2. Hanyang University 2. South Korea
3. University of Limerick 3. Ireland
I . Loughborough University I. LIK
l0 Clarissa Athaya Aglin 2. The University of Texas at Austin 2. USA
3. University of Toronto 3. Canada
I, The University of Warwick I. England
l1 Damien Abel Tj ioevani 2. Mahidol University 2. Thailand
3. Monash University 3. Australia
1. Osaka university l. Jepang
12 Deni wahyudianto 2. University of Waterloo 2. Canada
3. University Sains Malaya 3. Malaysia
1 KTH Royal Institute of Technology
. I . Swedia

l3 Desanti Amelia 2. University of Szeged 2. Hungaria

3. Georgetown University 3. Amerika Serikat
1 . Middle East Technical University 1. Turki
14 Devandra Deal Fatahillah 2. Universiti Malaya 2. Malaysia
3. Universiti Kebangsaan Malaysia 3. Malaysia
 KEMENTERIAN PENDIDIKAN, KEBUDAYAAN,RISET, DAN TEKNOLOGI
UNIVERSITAS SUMATERA UTARA
Jalan Dr. T. Mansur Nomor 9 Kampus USU Medan 20155
Telepon (06 1 ) 82 1 1 633, 821 657 5, Faximile (06 1 ) 82 1 94 1 1, 821 1 822, 821 17 66
Laman www.usu.ac.id

1. Sa enza Universi of Rome L Rome Ital

l5 Divhenia Putri Allysa 2. University of Pecs 2.Hunsary
3. Universiti Malaya 3. Malaysia
1. Palack! University Olomouc I. Czechia
l6 Dwie Rizqa Sabina 2. University of Pecs 2. Hungary
3. Middle East Technical University 3. Turkey
I. The University of Queensland l. Australia
17 Edbert Nathaniel 2. The University of Adelaide 2. Australia
3. University of Southampton 3, United Kingdom
I . Hanyang University L South Korea
l8 Edwina Patrecia Ronauli Sibarani 2. Keio University 2. lapan
3. University of Pecs 3. Hungary
'l
1. Korea Universitv . South Korea
t9 Elin Betsey Br Ginting 2. University of Padua 2. ttaly
3. Westem Universitv 3. Canada
I . University of Sheffield I. UK
20 Erick Lorus 2. Aix-Marseille University 2. France
3. University of Zagreb 3. Croatia
1. University of Pdcs I . Hungary
21 Fani Windari 2. University of Limerick 2. Ireland
3. Maastricht University 3. Netherlands
l. University of Granada L Spain
22 Fanny Novitadewi 2. Middle East Technical Universitv 2. Turkey
3. National Taiwan University 3. Taiwan
23 Fatrycia Grace Sianipar | . Queen's University Belfast I, UK
 KEMENTERIAN PENDIDIKAN, KEBUDAYAAN,RISET, DAN TEKNOLOC I
TINIVERSITAS SUMATERA TITARA
Jalan Dr, T. Mansur Nomor 9 Kampus USU Medan 20155
Telepon (06 1 ) 82 I 1 633, 821 657 5, Faximile (06 I ) 821 941 1, 821 I 822, 821 l7 66
Laman www.usu.ac.id

2. Universita di Siena 2. ltal

3. Massey University 3. New Zealand
1. Maastricht University I. Netherlands
24 Cavriel Emesto Betheloniva Sembiring 2, Western University 2. Canada
3. University College Dublin 3. Ireland
l. University of Leicester L United Kinedom
25 Grant Gabriel Tambunan 2. University of York 2, United Kingdom
3. University of Leeds 3. United Kingdom
L University of Waterloo 1 . Canada
26 Haris Fadhillah Nasution 2, Boston University Metropolitan College 2. USA
3. University of Zagreb 3. Croatia
L Maastricht University I. Netherlands
27 Harry Hamara 2. Universiti Sains Malaysia 2. Malaysia
3. University of York 3. UK
1, Keio University I . Japan
28 Hilmi Muthahhari Situmorang 2. Singapore Management University 2. Singapore
3. Osaka University 3..lapan
L University College Dublin I. Ireland
29 Ilfa Nadhira Afiqa 2, Victoria University of Wellington 2. New Zealand
3. University of Sheffield 3. United Kingdom
1 University of Granada
. 1. Spain
30 Jasmine Putri Arnanda 2. Middle East Technical University 2. Turkiye
3. University of Padua 3. Italia
1. Hanyang University L South Korea
3t Jason Sendytio
2. Korea University 2. South Korea
 KEM ENTERIAN PEN DIDIKAN, KEB U DAYAAN,RISET, DAN TEKNOLOGI
TINIVERSITAS ST]MATERA IITARA
Jalan Dr. T. Mansur Nomor 9 Kampus USU Medan 20155
Telepon (061) 8211633, 8216575, Faximile (061) 821941l, 8211822,8211766
Laman www.usu.ac.id

3. Osaka Universi 3.J

I. Universiti Malaya l. Malaysia
32 Jayanti 2. National Taiwan University ofScience and Technology 2. Taiwan
3. Universite de Caen Normandie 3. France
l. Maastricht University I. Netherlands
JJ Jelfry 2. University of Padua 2. ttaly
3. University of Granada 3. Spain
1. University of Szeged l. Hungary
34 Jesica Angel Br. Butar-Butar 2. Loughborough University 2. United Kingdom
3, Monash University 3. Australia
L Comell University I. USA
35 Jessica Jacqueline Titah Rumia Panjaitan 2. University of Waikato 2. New Zealand
3. Mahidol University 3. Thailand
l. Michigan State University I. USA
36 Johanes Alberto Siahaan 2. University of Padua 2.ltaly
3. Universiti Malaya 3. Malaysia
I . Universite de Caen Normandie L France
3t Joy Grace Simorangkir 2. Hanyang University 2. South Korea
3. University of Pisa 3. Italy
l. University of Canterbury l. New Zealand
38 Karin Priscilla Hannaniah Siahaan 2. University of Waikato 2. New Zealand
3. Sophia University 3. Japan
I . Newcastle University 1. United Kingdom
39 Karyn Questi Turnip 2. University of Bath 2. United Kingdom
3. University of Leicester 3. United Kingdom
 KEMENTERIAN PENDTDIKAN, KEBUDAYAAN,RISET, DAN TEKNOLOCI
LTNIVERSITAS ST]MATERA UTARA
Jalan Dr. T. Mansur Nomor 9 Kampus USU Medan 20155
Telepon (06 I ) 82 1 1633, 82 I 657 5, Faximile (06 I ) 82 I 94 I 1, 821 I 822, 82 I 17 56
Laman www.usu.ac.id

I . Korea Universi I. Korea

40 Keisya 2. Hanyang University 2. Korea
3. University of Zagreb 3. Croatia
I. University of Hanyang ( South Korea) I. South Korea
41 Kevin Maverick 2. University of Granada 2. Spain
3. Universit of Waikato 3. Nerv Zealand
l. University of California Davrs I. USA
42 Khalisa Shafa Aliya 2. University of Waikato 2. New Zealand
3. Victoria University of Wellington 3. New Zealand
I . University of Zagreb I. Croatia
{J Laila Dwiputri Febriany 2. University of Pecs 2. Hungary
3. Vytautas Magnus University 3. Lituania
L Vytautas Magnus University I . Lithuania

44 Leoni Nazareta Ambarita 2. University of Zagreb 2. Croatia

3. Korea University 3. South Korea
1. University College London L United Kingdom
45 Lydia Nauli Simanjuntak 2. University of Birmingham 2. United Kingdorn
3. University of Liverpool 3. United Kingdom
l. Keio University 1 . Jepang
46 Marcheline Darmawan 2. Universitv of Padua 2.ltalia
3. Monash University 3. Australia
l. Universite de Caen Normandie I. France
47 Marsia Br Pelawi 2. Victoria University of Wellington 2. Nerv Zealand
3. Universiti Malaya 3. Malaysia
48 Mayumi Wijaya L University of Warsaw I. Poland
 KEMENTERI AN PENDIDIKAN, KEBUDAY AAN,RISET, DAN TEKNOLOGI
UNIVERS ITAS SIIMATERA UTARA
Jalan Dr. T. Mansur Nomor 9 Kampus USU Medan 20155
Telepon (061) 8211633,8216575, Faximile (061) 82 l94l 1,8211822,8211766
Laman www.usu.ac.id

2. Sa ienza Universi of Rome 2. Rome Ital

3. Prince of Songkla University 3. Thailand
l. Washington, DC,
I. Georgetown University
USA
49 Melati Ervi Syahrani 2. Aix-Marseille University 2. France
3. University of Lirnerick 3. Ireland
L Osaka University 1 . Japan
50 Meliyeti Kosasih 2. Lomonosov Moscow State University 2. Russia
3. Universitv of Waikato 3. Nerv Zealand
L University of Waikato I . Nerv Zealand
5I Miqdad Zephanda 2. Viotoria University of Wellington 2. New Zealand
3. Belarusian State University 3. Belarus
1.KTH Royal Institute ofTechnology I. Sweden
52 Miranda Ibreni Basita br. Malau 2. Universitv of Granada 2. Spain
3. University of Pecs 3. Hungary
L National Tairvan Unrversity I. Taiwan
53 Muhamrnad Shandy Nugraha 2. Middle East Technical Universitv 2. Turkey
3. Unrversiti Malaya 3. Malaysia
1. Maastricht University 1 . Belanda

54 Najwa Safita 2. Universitv of Leicester 2. UK (Ineeris)

3. University of Warsaw 3. Polandia
1 . Korea University 1 . Korea
55 Namira Bilqis Rambe 2. University of Granada 2. Spain
3. Keio University 3. Japan
56 Nicholas Hansen I . Singapore Management University 1. Singapore
 KEMENTERIAN PENDIDIKAN, KEB U DAYAAN,RI SET, DAN TEKNOLOGI
T]NIVERSITAS STIMATERA TITARA
Jalan Dr. T. Mansur Nomor 9 Kampus USU Medan 20155
Telepon (061) 8211633, 8216575, Faximile (061) 8219411, 8211822,8211766
Laman www.usu.ac.id

2. Universiti Mal a 2 sla

3. Universiti Sains Malaysia 3. Malaysia
L Maastricht University I. Belanda
57 Nofita Widya Pratama 2. Georgetown University 2. Amerika Serikat
3. University of Limerick 3. Irlandia
l. Michigan State University I. USA
58 Noviani Sakinah 2.Hanyang University 2. South Korea
3. University of Pecs 3. Hungary
l. University of Leeds I. United Kingdom
59 Qanira Khalishah 2. Korea University 2. South Korea
3. Universitv of Pecs 3. Hungary
I. University of Groningen L Netherlands
60 Rachel Valencia 2. University College Dublin 2. Ireland
3. University of Liverpool 3. United Kingdom
l. Michigan State University I. USA
6l Rafael Daniel Sranipar 2. Humboldt-Universitat zu Berlin 2. German
3. University of Limerick 3. Ireland
I . Universitv of Padua L ltaly
62 Raudhatul Jannah 2. University of Waikato 2. New Zealand
3. Universiti Malaya 3. Malaysia
I. University of Glasgow I. Skotlandia
63 Raybina Aurelia 2. University of Groningen 2. Netherlands
3. Massey University 3. New Zealand
l. University of Liverpool I, UK
64 Ridwan Firmansyah
2. Aalto University 2. Finland
 KEMENTERTAN PENDTDIKAN, KEBUDAYAAN,RISET, DAN TEKNOLOGI
TINIVERSITAS STI ]IIATERA TITARA
Jalan Dr. T. Mansur Nomor 9 Kampus USU Medan 20155
Telepon (06 I ) 82 1 I 633, 821 657 5, Faximile (06 I ) 821941 l, 821 I 822, 821 17 66
Laman www.usu.ac.id

3. National Kun Universi (NCKU) 3. Taiwan

l. United states of
L Yale University
america
65 Rifki Ananda 2. Keio University 2. Japan
3. National University of Malaysia 3. Malaysia
I. Aalto University I . Finland
66 Risky Ramadhan HTS 2. University of Galway 2. Ireland
3. Victoria University of Wellinglon 3. New Zealand
I . Boston University Metropolitan College I. USA
67 Rivael Banata Simangunsong 2. University of Warsaw 2. Poland
3, Universitat Pompeu Fabra 3. Spain
L University of Groningen I. Netherlands
68 Sabrina Marisi Siahaan 2. Charles University 2. The Czech Republic
3, University of Waikato 3. New Zealand
I , Humboldt-Universitlt zu Berlin L Germany
69 Sarmida Uli Sinaga 2. Palackyi University Olomouc 2. Czech Republic
3, University of Bath 3. United Kingdom
L University of York I . Britania Raya

70 Shafa Yasmin As Sajidah 2. University of Leicester 2. Britania Raya

3. Middle East Technical University 3. Turki
L National Taiwan University l. Taiwan
7t Shafiyah Zahra Sahri 2. Universiti Kebangsaan Malaysia 2. Malaysia
3. Prince of Songkla University 3. Thailand
l. University of Padua I . ltaly
72 Siti Kalyca
2. University of Pisa 2. Italy
 KEMENTERIAN PENDIDIKAN, KEBUDAYAAN,RISET, DAN TEKNOLOGI
TTNIVERSITAS SUMATERA TTTARA
Jalan Dr, T. Mansur Nomor 9 Kampus USU Medan 20155
Telepon (061) 8211633,8216575, Faximile (061) 821941 1 ,8211822,8211766
Laman www.usu.ac.id

3. Universi of Granada 3.S ln

l. Universitv of Pisa 1 . Italy

73 Stefanny Vinchent 2. Palackii University Olomouc 2. The Czech Republic

3. University of Siena 3. Italy
L Korea University I. South Korea
74 Stefany Yulianda Colia 2. University of Pompeu Fabra 2. Spain
3. University of Pecs 3. Hungary
l. National Taiwan University of Science & Technology l. Taiwan
75 Stephany 2. Hanyang University 2. Korea
3. Universiti Malaya 3. Malaysia
l. The Australian National University l. Australia
76 Steven Tan 2. The University of Adelaide 2. Australia
3. The University of Western Australia 3. Australia
l. Hanyang University L South Korea
77 Tiara Putri Hardini 2. University of Southampton 2. United Kingdom
3. Mahidol University 3. Thailand
1. University of Bath I. UK
78 Tobias Davino Purba 2. University of Szeged 2. Hungary
3 KTH Royal lnstitute ofTechnology 3. Sweden
L Singapore Management University L Singapore
'79 Valerin Veny 2. Universiti Malaya 2. Malaysia
3. Universiti Sains Malaysia L Malaysia
I . Michi State University I. United States
80 Vanness Cantona 2. University of Toronto 2. Canada
3. University of York 3. United Kingdom
 KEMENTERIAN PENDIDIKAN, KEBUDAYAAN,RISET, DAN TEKNOLOGI
T]NIVERSITAS STIMATERA UTARA
Jalan Dr. T. Mansur Nomor 9 Kampus USU Medan 20155
Telepon (06 1 ) 82 1 1 633, 821 657 5, Faximile (06 1 ) 82 1 94 1 1, 821 1 822, 821 17 66
Laman www.usu.ac.id

I. Comell University l. The USA

8l Viory Hizkia Hutauruk 2. University of Califomia Davis 2. The USA
3. Michigan State University 3. The USA
I . Universitat Pompeu Fabra ISpain
82 Wilbert Neilson Sachio 2. University of Southampton 2. United Kinedom
3. Universitv of Padua 3. Italy
L Nanyang Technological University L Singapore
83 Williarn Diharjo 2. Keio University 2. Japan
3. Monash University 3. Australia
L University ol Szeged L Hungary
Wulan Stefanni Ephipanias Elysabeth
84 2. University of Padua 2. Italy
Manurung
3. Maastricht University 3. Netherland
 KEMENTERIAN PENDIDIKAN, KEBUDAYAAN,RISET, DAN TEKNOLOGI
T]NIVERSITAS SUMATERA UTARA
Jalan Dr. T. Mansur Nomor 9 Kampus USU Medan 20155
1 1 633, 821 657 5, Faximile (06 1 ) 82 1 94 1 1, 821 1 822, 821
Telepon (06 1 ) 82 17 56
Laman www.usu.ac.id

University of Limerick Ireland

85 Yemima Missy Pasaribu Newcastle University UK
University of Sussex UK
University of Szeged Hungaria
86 Yessi Evani Manihuruk Mahidol Universi Thailand
Universiti Kebangsaan Malaysra Malaysia

Medan,2l Februari 2024

Wakil Rektor Bidang Akademik, Kemahasiswaan dan Kealumnian
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