AGREEMENT FOR INTERNATIONALACADEMIC EXCHANGE AND COLLABORATION

between

FACULTY OF MEDICINE DIPONEGORO UNIVBRSITY

and

DT. KARIADI HOSPITALwith

FACULTY AND GRADUATE SCHOOL OF HEALTH SCIENCES

HOKKAIDO UNIVBRSITY

Faculty of Medicine Diponegoro University and Dr. Kariadi Hospital as well as

Faculty and Graduate School of Health Sciences, Hokkaido University consent to joinin the following agreement on the basis of equality and reciprocity to promote

international academic exchanges and collaboration through mutual aid on education

and scientific research.

I. GENERAL FORMS OF COOPERATION(l) Joint researches

(2) Lecturers exchange

(3) Students exchange (including joint scientific direction of thesis work, internship

in final semester)

(4) Information exchange concerning education and research

(5) Publications exchange in scientific or technical nature

(6) Joint publication of scientific results and educational material

(7) Mutual courses and seminars organization

2. FINANCIAL ARRANGEMENTSAll financial arrangements for cooperation described above shall be negotiated in

each specific case and determined by both schools and the hospital that do not have

financial obligation to each other.

3. INTELLECTUAL PROPERTY

Before beginning any collaborative research, both education institutions as well as

the hospital shall agree, in writing all substances that related to any intellectualproperty that may become apparent during research.

4. OBSERVANCE

Exchange programs and collaboration shall be carried out according to the rules and

regulations of the jurisdiction of each country.

5. FUNDAMENTAL HUMAN RIGHTSBoth education institution and the hospital do not discriminate any visiting facultymembers, research staff, or students on the basis of race, gender, age, ethnicity,religion, or national origin.

6. VALIDITY OF THE AGREEMENTThe particular agreement is made in English, Japanese, and Indonesian language

copies and all being equally authentic. The agreement shall come into effect on the

date of the signatures valid for a period of five years. This agreement will be

automatically renewed every five years subsequently unless either party notifies itsintension of termination and should be announced at least 6 months prior to the

cessation date.

Signed at Semarang, Indonesia

Date: Dece mber 4rt', 2012

Endang Ambarwati , M.D.

Dean, Faculty of Medicine

Diponegoro University

Semarang, Indonesia

L.,/

Bambang !Vibowo. M.D.

President Director

Dr. Kariadi Hospital

Semarang, Indonesia

l'l*96Hiroyuki Date, Ph.D.

Dean, Faculty and Graduate

School of Health Sciences

Hokkaido University

Sapporo, Japan

PBRJANJIAN UNTUK MELAKUKAN

PERTUKARAN AKADEMIK INTBRNASIONAL DAN KERJASAMA

antara

FAKULTAS KEDOKTBRAN UNIVERSITAS DIPONEGORO dAN

RSUP DR.I(ARIADI

dengan

FACALTY AND GRADAATE SCHOOL OF HEALTH SCIENCES

HOKKAIDO ANIVERSITY

Fakultas Kedokteran Universitas Diponegoro dan RSUP Dr. Kariadi serta Faculty and

Graduate School of Health Sciences, Hokkaido University bersepakat untuk melakukan

perjanjian dengan dasar kesamaan dan hubungan timbal balik untuk melakukan

pertukaran akademik secara internasional melalui kerjasama dalam bidang pendidikan

dan penelitian ilmiah.

I. BENTUK KERJASAMA SECARA UMUM(1) Penelitian bersama

(2) Pertukaran dosen / staf pengajar

(3) Pertukaran mahasiswa (termasuk bimbingan ilmiah pembuatan thesis, semester

akhir kepaniteraan klinik)(4) Pertukaran informasi tentang pendidikan dan penelitian

(5) Pertukaran publikasi dalam bidang ilmiah dan teknik.(6) Publikasi bersama hasil penelitian ilmiah dan materi pendidikan.

(7) Kerjasama penyelenggaraan kursus dan seminar.

2. PENGATURAN KEUANGANSemua pengaturan keuangan dalam rangka kerjasama yang diuraikan di atas akan

dibicarakan secara spesifik dan ditentukan oleh kedua institusi pendidikan dan rumah

sakit dan tanpa ketergantungan satu sama lain.

3. HAK MILIK INTELEKTUALSebelum memulai penelitian kolaborasi, institusi pendidikan dan rumah sakit harus

menyetujui secara tertulis semua materi yang berkaitan dengan hak milik intelektual

yang akan diperoleh pada penelitian tersebut.

4. KETAATAN PADA REGULASIProgram pertukaran dan kerjasama harus menurut hukum dan regulasi tiap negara.

5. HAK ASASI MANUSIAKedua institusi pendidikan dan rumah sakit tidak mendiskriminasi staf pengajar, staf

riset atau mahasiswa yang berkunjung, berdasarkan ras, jenis kelamin, umur, etnis,

agama dan kebangsaan.

6. VALIDTTA S PERJANJIAN

Perjanjian ini dibuat rangkap dalam bahasa Inggris, Jepang, dan Indonesia; semua

mengandung arti yang sama dan otentik. Perjanjian mulai berlaku sesuai tanggal

penandatanganan sampai 5 tahun kemudian. Perjanjian akan diperbarui secara

otomatis tiap 5 tahun, kecuali ada permintaan dari salah satu pihak untuk

membatalkan dan memberitahu setidaknya 6 bulan sebelum penghentian perjanjian

ini.

Ditandatangani di Semarang, Indonesia

Pada tanggal 4 Desember 2012

Dr. Endang Ambarwati, Sp.KFR Dr. Bambang Wibowo,Sp.OG(K) Prof. Hiroyuki Date, Ph.D.

Dekan Fakultas Kedokteran Direktur Utama Dean, Faculty and Graduate

t'h^WSchool of Health Sciences

Hokkaido University

Sapporo, Japan

Universitas Diponegoro

Semarang, lndonesia

RSUP Dr. Kariadi

Sernarang, lndonesia

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NOTATION FOR STUDENT EXCHANGEbetween

.FACULTY OF MEDICINE DIPONEGORO TJNIVERSITY

'Dr. KARIADI HOSPITALand

.FACULTYAND GRADUATE SCHOOL OF HEALTI"I SCIENCESHOKKAIDO UNIVERSITY

Faculty of Medicine Diponegoro University, Dr. Kariadi Hospital and Faculty andGraduate School of Health Sciences, Hokkaido University shall conduct the studentexchange programs on the basis of AGREEMENT FOR INTERNATIONALACADEMIC EXCHANGE ratified on December 4'r'. 2012.

I. SELECTION FOR VISITING STUDENTSThe home school shall norninate its own students for exchanging, but final admissionshall be determined by the host school or hospital. As a rule, an application forrnshould be submitted within an application period set by the host school.

2. NUMBER OF VISITING STUDENTSEach institution will enroll no more than 5 students from the other each year;however, this nr"rmber can be increased for a specified year with prior and mutualapproval of the home and host institutions

3. VISITING PERIODVisiting period is less than one year, as a rule.

4. INSPECTION, ADMISSION, AND TUITION FEEEacli scliool or hospital shall waive inspection, admission, and tuition lees for visitingstudents.

5.TRAVELAND LIVING EXPENSES DLJRING VISITVisiting students or their sponsors are responsible for their travel and living expensesduring visits to the other school or hospital.

6. LANGUAGEThe working language in both schools is English. If it is not English, a tutorappointed by the host school will translate it to English on the spot, offering a

convenience for visiting students.

7. INDEMNIFICATIONBoth schools and the hospital shall discuss about the expenses, damages or losseswhich are incurred due to the acts or omissions of an indemnil'ying visiting student ineach special case, and determine the indemnity by the student or home school.

8.INSURANCEThe home school sliall guarantee that any visiting student carries adequate healtli ar.'d

accident insurance in the period of traveling and visiting.

9. VALIDITY OF THIS NOTATIONThis notation is valid for the same period from the date of signing as that ofAGREEMENT FOR INTERNATIONAL ACADEMIC EXCHANGE betn'een FACTJI-TY OF

MEDICINE, DIPONEGORO LjNIVERSITY, Dr. KARIADI HOSPI'|AI- and FACTJTLY ANDGRADUATE SCHOOL OF HEALTH SCIENCES, HOKKAIDO LJNIVERSI'IY.Any amendment of this notation shall require written approval of both schools andthe hospital.

Signed at Semarang, Indonesia

Date: Dece mber 4't', 2012

Endang Ambarwati , M.D.

Dean. Faculty of Medicine

Diponegoro Universit;

Semarang, lndonesia

Bambang Wibow6, M.D.

President Director

Dr. Kariadi Hospital

Semarang, Indonesia

f'l''DWHiroyuki Date. Ph.D.

Dean. Faculty and Graduate

School of Health Sciences

Hokkaido University

Sapporo, Japan

CATATAN UNTUK PERTUKARAN MAHASISWAantara

. FAKULTAS KBDOKTBRAN UNIVERSITAS DIPONEGORO. RSUP DR. KARIADI

dan. FACULTY AI,{D GRADUATE SCHOOL OF HEALTH SCIEI{CES

HOKKAIDO UNIVERSITY

Fakr,ltas Kedckteran Universitas Diponegoro, RSUP Dr. Kariadi, dan Fucutitl' anC

Grctdudte School of HectLth Sciences, Hokkaidct Un.iver.sitt,akan rnelaksanakanpertukaran mahasiswa berdasarkan AG REEM ENT FO R I IVTE RN ATI O N AL AC AD E' M ICEXCH.4IVGE yang disahkan pada tanggal 4 Desember 2012.

I. SELEKSI I/ISITING STUDENTInstitusi asal memilih mahasiswa untuk program pertukaran, tapi keputusan terakhirditentukan oleh institusi penerima. Formulir aplikasi harus diserahkan dalam jangkawaktu yang sudah ditentukan oleh institLrsi penerima.

2. JL]MLAH \,'ISITING STUDENTSSctiap institusi akan mengirim maksimal 5 mahasiswa setiap tahunnya, tetapijumlahterseb';t brsa lcbih darijika ada perjanjian sebelrrmnya antara institusi asal dan

institusi penerima.

3. WAKTU BERKLJNJUNGW'aktu berkLrniung kurang dari satu taliun.

4, INSF'EKSI, L],\NG MASUK DAN UANG SE,KOLAHSetiap institusi pendidikan dan rumah sakit akan meniadakan biaya inspeksi, uangmasuk dan uang sekolah dari visiting stuCents.

.5. tsIAYA PERJALANAN DAN BIAYA HIDUP SELAMA KUNJUNGANN{ahasiswa yarrg berkunjung atau spr-rnsor bertanggung jawab atas perjalanan clan

biaya h;dup vi.siting .ttudents selama kunjur gan ke sekolah atau nrnrah sakit.

6. BAHASABahasa yang digunakan adalah bahasa Inggris. Apabila tidak menguasai bahasaInggris maka inst-itu'si penerima akan menunjuk tutor yang akan menerlernahkan ke

d;rlarn bahasa Inggris dengan memperhatikan perasaan nyaman dari vi.sitirtg stutlen.t.s.

7. G.\NTI RUGIKedua sekclali dan rumah sakit akarr merrbahas fentang bial'a. kerusakan dan

l.:ehilartgan yern3 terjadi akibat perbuatan atau kelalaian dari visiiirtg studenis aan,

,rene:tuliun apakah ganti rugi dibebankair kepada visiting strttlen.ts atau insiitusipe.rgirirn.

8. ASI JR,\NSIInstitusi pengirim menjamin bahwa setiap vis'itittg students mernprinyai asulansikesehatan clan kecelak.aan selama waktu perjalanan Can kunjLrrrgan.

9. VALIDITAS CATATAN PE,RTUKARAN MAHASISWACatatan pertukaran mahasiswa ini berlaku sesuai jangka waktu PERJANJIAN UNTUKMELA KUKA N PERTUK.ARA N A KADEM I K I NTERNAS I ONA L antaTa FA KULTA S

KEDOKTERAN UNI\/ERSITAS DIPONEGORO, RSUP DR. KARIADI dAN

FACLTLY AND GRADUATE SCHOOL OF HEALTH SCIENCES, HOKKAIDOTJNIVERSITY.Setiap amandemen dari catatan ini memerlukan persetujuan dari kedua institusipendidikan dan rumah sakit.

Ditandatangani di Semarang, Indonesia

Pada tanggal 4 Desember 2012

Dr. Erciang Anrbarv''ati, Sp.KFR

Dekan Fakultas Kedokteran

l- niversitas Di pcn.:goro

Senrar:ng, Inrionesia

Dean, Faculty and Graduate

School of flealth Sciencss

Hol<kaido University

Sapporo, Japan

tDr. Bambang W/Uo*o.Sp.OG(K) Prof. Hiroyuki Date, Ph.D

't^96Direktur Utarna

RSUP Dr. Kariadr

Semarang, lndonesia

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