The Board of Trustees (Majelis Wali Amanat/MWA) of Universitas Sumatera Utara was established in 2004 through a Decree of the Minister of National Education, with members comprising representatives from the government, academia, and society. The board was initially led by Dr. (Hc) Raja Inal Siregar as Chair and Prof. Dr. Alvi Syahrin, SH, MS as Secretary. During the 2004–2009 period, several interim replacements took place, and in 2009, a new composition for the 2009–2014 term was formalized through a ministerial decree.

The USU Board of Trustees (MWA) for the 2009–2014 period was led by Joefly J. Bahroeny as Chair and Prof. Dr. Alvi Syahrin, SH, MS as Secretary, with several interim member replacements made through ministerial decrees until the end of the term, which was later extended by one year. In 2015, the Minister of Research, Technology, and Higher Education appointed new members for the 2015–2020 term, and in 2014, USU officially changed its status to a State University with Legal Entity (PTN-BH) under Government Regulation No. 16 of 2014, which affirmed MWA's role as the body responsible for determining the university's general policies.

The USU Board of Trustees (MWA) for the 2015–2020 period was initially led by Prof. Dr. Todung Mulya Lubis, SH, LLM, as Chair and Fahmi Natigor Nasution as Secretary. In 2018, Prof. Todung resigned following his appointment as Indonesia’s Ambassador to Norway and Iceland, and was subsequently replaced by Drs. H. Panusunan Pasaribu, M.M., through an acclamation. In the same year, interim replacements of MWA members were made by ministerial decree, appointing Prof. Dr. Zul Alfian, M.Sc. and Ir. H. Razali Ishak to replace two previous members.

The USU Board of Trustees (MWA) for the 2020–2025 period was led by Dr. Nurmala Kartini Pandjaitan Sjahrir as Chair and Prof. Dr. Guslihan Dasa Tjipta, Sp. A(K) as Secretary, both elected by acclamation, with members appointed through a Decree of the Minister of Education and Culture in October 2020. During this period, several interim member replacements occurred due to resignations, changes in Academic Senate representation, and the passing of a member, all of which were governed by the relevant ministerial decrees.

MWA USU for the 2025–2030 period is chaired by Police General (Ret.) Drs. Agus Andrianto, S.H., M.H., Dr. Inke Nadia Diniyanti Lubis, PGDip PID, M.Ked(Ped), Sp. A, Ph.D., serving as Secretary, both elected by acclamation. The composition of MWA members was officially determined through the Decree of the Minister of Higher Education, Science, and Technology No. 182/M/KEP/2025 dated May 28, 2025, listing 21 members from government, academic, and public representatives.