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Consent Form for Collection and

Use of Personal lnformation
fi Collection and lJee of Personal lnformation

1. ltems: Name, Date ol Bifth, Address, Email Address, Contact lnformation, Educationa Background,
ation/position, Work Experience, etc.
2. Purpose o{ Collection and Usei Verification of personal information, Human resource management
3 Retention Period: Until the purpose is achieved

M Agree n Disagree

B Provision and Entrustment of Personal lnformation to Third Parties

1. Recipients of the InJormation: Ministry of Education of Korea/Pariner Country and Postal Delivery Aqency
2. ltems: Name, Date of Binh, Address, Email Address, Conta.t lnformatlon, etc.
3. Pupose of Collection and Use: Delivery of pubUcatlons, Human resour.e management
4. Retention Period: nformalion sMll be destroyed without delay after the purpose is achieved.

M Agre€ tr Disaqree

A Collection and Use of Activity lnformation

1. liems: Reports (plan for educational activities, project report monthly reports, lesson reports, final report,
etc.), the Process and Results of Adivity (photos, videos, class maierials, recording, etc.)
2. Purpose of Collection and Usei Secondary utiization (repodr video production, news production, etc.)
and intellectual propeny right of the secondary works belong to the Ministry o{ Education Korea and the
Asia Pa.ific Centre of Edu.ation for lnternationa Understanding
3. Retention Period: nformation shall be destroyed without delay after the purpose is achieved.
4. lnf.ingement of ihe Rights: When participants'submissions (repo'1s, photographs, videos, etc.) infringe
others' rights (po.trait rights. intelledual p.operty righ6 etcJ, the responsibility lies wirh the .reator of the

d Agree tr Disagree
I You have the right to wiihhold your consent to ihe col ection and use of your personal
However, in the event that you withhold your consent, you will not be able to participate
Teacher Eichange fot Glabal Education.

20. MAY. 2023

SMAN 3 PADANG
Country of Origin INDONESIA
PANJANG

f lren J,tL4p-nrt ka. t ,W

 ic? Effi :aPcrtu

Consent Form for Collection and

Use of Personal lnformation
I Collection and Use of Personal lnfotmation
1. lt€ms: Name, Date of Birth, Address, tmail Address, Contact lnformation. Educational Background, affili
ation/position, Work Experience, etc.
2. Purpose of Collection and Use Verification of peEonal information, Human resou.ce management
3. Retention Pe.iod: Until the purpose is achieved

d Agr€€ tr Disagree

- Provision and Entrustment of Personal lnformation b fhird Parties

1. Recipients of the lnformation: Minisky of Education of Korea/Partner Country and Postal Delivery Agency
2. ltems: Name Date of 8irth, Address, Email Address, Contact lnformation, etc.
3. Purpose of Collection and Use: Delivery of publications, Human resour.e managem€nt
4. Retention Period: lnformation shall be destroyed without delay after the purpose is achieved-

g/Agree tr Disagaee

I Collection and Use of Actiity lnformation

1. ltems: Reports (plan for educational activities, p.oject report, monthly reports, lesson reports, final repon,
(photor videot .lass materialr re.ording, etc)
etc.), the Process and Resullts of Activity
2. Purpose of Collection and Use: Seconda.y utilization (reports, video productioa n€ws production, etc.)
and intellectual property right of the s€condary works belong to the Mininry of Education Korea and the
Asia-Pacific Centre of Education for lnternational Understanding
3- Retention Period: lnformation shall be desiroyed without de ay after the purpose is achieved.
4. lnfringement of the Rights: When pai{icipants' submissions (reports, photographs, videor etc.) infringe
others' rights (portrait rights, intelle.tual property rights, etc), the .esponsibility lies with the creator of the

Aqr€e tr Disagree

' You have the right to withhold your consent to the collection and use of your personal information.
However, in the event that you withhold your consent you will not be able to paniopale in the Asia-Pacific
feachet [xchange for Global Educatio

20. MAY. 2023

SMAN 3 PADANG
Country oI O.igin INDONESIA School
PANJANG
Name D,M 4t+.rt<i,It<aw v/lvw,"-t
A-.-
g)) xT:.. .^ ^llul APCrU

Consent Form for Collection and

Use of Personal lnformation
M Collection and Use of Personal lnformation
1. ltems: Name, Date oi 8irth, Addre5s, Email Addrest Contact lnformation, Educational Background, affili
ation/position, Work Experience, etc.
2. Purpos€ of Colleclion and Use Verification of pe.sonal inforrnation, Human resource management
3. Retention Period: Until the purpose is a.hieved

dAgree D Disgree
g Provision and Entrustmerrt of Petsonal lnformation to Third Parties
1. Recipients of the lnformation: Ministry of Education of Korea/Pa(ner Country and Postal Delivery Agency
2. liems: Name, Date of Birth, Addrest Email Address, Contact lnformation, etc
3. Purpose of Collection and Use: Delivery of publications, Human resource manag€ment
4. Ret€ntion Period: lnformation shall be destroyed without delay after the purpose is achieved.

d Agree tr Disagree

g Collection and Use of Activity lnfomation

l. ltemsi Reports (plan for educational ..tivities, pro.ject report, monthly reports, lesson r€ports, final report,
etc), the Process and Results of Activity (pl"rolos, videos, class materialt recording, etc.)
2. Purpose of Collection and use: Secondary utilization (repo(t video production, news produ€tion, etc)
and intellectual property right of the secondary works belong to the Ministry of Edu(ation Korea and the
Asia-Pacific Centre of Education for lnternational Ljnde6tanding
3. Retention Period: lnformation shall be destroyed without delay after the purpose is achieved-
4. lnf.ingement of the Righrs: When participants' submissions (reports, photographs, videos, etc) infringe
others' rights (portrait right5 intellectual property rights, etc), the responsjbility lies with th€ creator of the

dAgree n oisagree
'You have ihe right to wkhhold your consent to the collection and use of your personal information.
However in the ev€nt that you withhold your consent you will not be abl€ to paniclpalei.n the Asia-Pacifrc
feacher Exchange fot Global Education.

Dabo\Mt€lg. 2023

Country of Origin [n0on eria tl,,nN ? f"asl

t.lt" fur^6', Jlrr
O **:*.^ fim iAPcEtu

Consent Form for Collection and

Use of Personal lnformation
d Collection and lJse of Personal lnformation
1. ltems: Name Dare of Birth, Addresr Email Address, Contact lnformation, Educational Ba.kground, afrili
ation/position, Work Erperience, etc
2, Purpose of Collection and Usei verifiartion of personal information, Human resource management
3. Retention Period: until the purpose is achieved

d Provision and Entnrstment of Personal lnformation to Third Parties

1 . Re.ipients of the lnformation: Ministry of tducation of Ko.ealPartner Country and Postal Delivery Ag€ncy
2. ltems: Name, Date of Birth, Addrest Email Address, Contact lnformation, etc.
3. Purpose of Collection and User Delivery of publications, Human resource rnanagement
4. Retention Period: information shall be destroyed without delay after the purpose is achieved.

Uasree tr Disagree

dco ectbn and Ltse of ,Activiry lnformation

l.ltems: Reports (plan for educational activitier project r€port, monthly reports, lesson reports, final report,
etc.), the Process and Results ol Adlvity (photos. videos, class mate.ials, recordlng, etcJ
2. Purpose of Co,lection and lJse: Secondary utilization (reports, video production, news production, etcJ
and intellectual property right of the secondary works b€long to the Ministry of Education Korea and the
Asia-Pa.ific Cent.e of Education tor lnternational understanding
3. Retention Period: lnformation shall be destroyed without delay after the puDose is achieved.
4. lnfringement of the Rights: When participants' submissions (reports, photographt videot etc) infringe
others' rights (portrait right' intelle.tual property rightt etc.), the responsibility lies with the caeator of the

Magree D oisagree
" You hav€ the right to withhold your .onsent to the collection and use of your personal information.
However, in the event that you withhold your consent, you will not be able to panicipale in lhe Asia-Paci0c
Teacher Exchange fot Global Education.

20. MAY. 2023

SMAN 3 PADANG
Country of origin INDONESIA School
PANJANG

Name RocALtNA , s. Pd ___4.X._