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