UCHC RESEARCH ADMINISTRATION AND FINANCE
FOREIGN NATIONAL EXPORT CONTROL COMPLIANCE VERIFICATION
Name of foreign national:
Country of citizenship:
Requested visa petition type: _________________________
Period: from
Requestor’s Name:
Academic Department/Center:
1.
to
Will the foreign national have access to information covered by a funded research project? No Yes If yes, please list projects (use additional pages as needed):
PI
Funding Agency
Title
Award Period
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
2.
Will the foreign national have access to materials covered by a Material Transfer Agreement? No Yes If yes, please list all MTAs (use additional pages as needed):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
3.
Will the foreign national have access to information covered by a confidentially or non-use, non-disclosure
agreement? No Yes If yes, please list all CDAs/NDAs (use additional pages as needed):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
4.
Please note any additional information that may be helpful in assessing whether the foreign national will have access
to technology/information that may be subject EAR/ITAR, e.g. access to equipment specifically designed or developed
for military or space applications; sponsor or third party proprietary or confidential information, materials, or
software; encrypted source code; or other proprietary technologies.
________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
R:/ORSP/Forms/export control review rev. 03-15-2011
UCHC RESEARCH ADMINISTRATION AND FINANCE
FOREIGN NATIONAL EXPORT CONTROL COMPLIANCE VERIFICATION (cont.)
I certify that:
I have read and understand UCHC's guidance on export control regulations. I am familiar with the job duties of
____________________ (foreign national). The information listed above reflects all sources of information, technical data, and
technology that may be accessible to ___________________(foreign national).
_____
OR
_____
Upon information and belief, in accordance with the Export Administration Regulations (EAR) and the International
Traffic in Arms Regulations (ITAR) ____________(foreign national) will not have access to export controlled
technology/information. S/he will only have access to technology/information that is not covered by or exempt from
EAR/ITAR regulations.
A determination from Research Administration and Finance is being sought regarding whether an export control
license or other such authorization is required prior to releasing export controlled technology or information to the
foreign national.
I agree to advise ORSP of any changes or additions (i.e., newly funded research projects or new agreements) and further agree
not to allow access to such information by the foreign national pending the outcome of the export control review.
Signature of Sponsoring PI
Date
______________________________________
Name of Sponsoring PI
Date
______________________________________
Name of Department Head
Reviewed by:
Signature of Department Head
Research Administration and Finance Use Only
I have reviewed the attached documentation and certify that:
With respect to the technology or technical data, the petitioner will release or otherwise provide access to
____________________________ (the foreign national), UCHC certifies that it has reviewed the Export Administration Regulations
(EAR) and the International Traffic in Arms Regulations (ITAR) and has determined that:
☐ A license is not required from either the U.S. Department of Commerce or the U.S. Department of State to release such
technology or technical data to the foreign person; or
☐ A license is required from the U.S. Department of Commerce and/or the U.S. Department of State to release such technology or
technical data to ______________________(foreign national) and UCHC will prevent access to the controlled technology or
technical data to_________________(foreign national) until and unless UCHC has received the required license or other
authorization to release it to _____________(foreign national).
Project Officer:
Date:
Institutional Signature:
Date:
Original of this document is to be submitted to the Department of Human Resources-International Office.
Please keep a copy of this document for your records
For more information: _________________________________________________________
R:/ORSP/Forms/export control review rev. 03-15-2011