Request for Consideration of
International Linkage Agreement
This form is a prerequisite to any international agreement entered into between Missouri
University of Science & Technology and an academic, governmental or private institution in
other nations of the world. Please complete and submit this form to the Office of International
and Cultural Affairs in order to facilitate a preliminary review of the proposed agreement.
Linkage agreement Type:
 New
 Renewal
 Revision and Renewal
 Institution-wide Linkage
 Department-wide Linkage
 Individual Faculty member Collaboration
I.
Proposed agreement International Partner/Missouri S&T Information:
Name & City of Proposed International Partner
Institution:
Name & Department of Proposed International
Partner Initiator:
Name of International Partner Principal
Contact:
Name and title of person who will sign MOU
for International Partner:
Name, Department & Title of Missouri S&TAgreement Initiator:
II.
Activity Type (please check all that apply):
 Faculty Research:
 Student Exchange and/or Study Abroad
Experience:
 International Training or Technical
Assistance. Please specify type or topic:
 Undergraduate Experience:
 Graduate Experience:
Please note: Student Exchange requires an appendix, parity and students’ financial commitment to home institution .
III.
Synopsys of Project: Please describe the scope and nature of this partnership.
IV.
Background information: please provide information about the partner institution in
terms of: reputation, areas of specializations, private or public, types of degrees, etc.
V.
Resources: If S&T funds or resources will be utilized, please provide details.
VI.
Partnership Goals: Please describe how this agreement contributes to S&T’s Strategic
Plan and the goals of the sponsoring department. If appropriate, indicate how this
agreement fits with other partnerships in the specific country or region.
Approval
The final agreement will be signed by the Missouri S&T Chancellor or his/her designee.
The Sponsoring Faculty Member and the Department Chair are responsible for notifying their
respective Dean of this potential agreement.
VII.
Name of Sponsoring Faculty Member:
___________________________
Signature of Sponsoring Faculty Member:
___________________________ Date:
Name of Department Chair:
___________________________
Signature of Department Chair:
___________________________ Date:
Assistant Director – Study Abroad
Office of International and Cultural Affairs: ___________________________ Date:
(if agreement includes Student Exchange Experience)
VIII. Missouri S&T Linkage Agreement Criteria: Missouri S&T International linkage
agreements must fit into one of the following categories in order to fit institutional needs.
Please indicate how the appropriate criteria will be implemented:
 Add prestige to Missouri S&T by the affiliation:
 Provide student benefit (through student recruitment, internships, study abroad, etc.):
 Promote specific good will/public relations:
 Promote research, contracts, or training:
VIII. Duration of the Agreement:
Proposed Begin Date:
_______________
Proposed End Date: ____________
Acknowledgement of Restrictive Clause
(Applicable To All Linkage Agreements)
This serves as acknowledgement by __________ of a restrictive clause placed in all Missouri
S&T linkage agreements. If you receive approval for your requested linkage, this restrictive
clause will be included in the proposed agreement.
The restrictive clause reads as follows:
“The terms of such mutual collaboration for each program and activity implemented under the
terms of Memorandum of Academic Cooperation Between The Curators of the University of
Missouri on behalf of Missouri University of Science and Technology, USA, and NAME OF
UNIVERSITY, COUNTRY, will be jointly discussed and agreed upon in writing by authorized
officials of both institutions prior to the initiation of the particular program or activity. Both parties
agree to diligently and strictly comply with any and all applicable U.S. export control regulations.
All activities will be based upon publicly available information and any resulting information will
be published and shared broadly in the scientific community.”
It is the responsibility of ___________to inform in writing other faculty, staff and students
(graduate or undergraduate) involved in this work/linkage agreement of the possibility of export
control implications and the restrictions associated with this project.
Acknowledgement:
I have read and understand the restrictive clause referenced above and am aware that it
will be included in this agreement. Further, I understand the possibility of export control
implications on this project and agree to comply with any conditions set forth to manage
such technology controls. I also agree to fully report any potential conflicts of interest
present with my involvement in this study.
Signature of Sponsoring Faculty:
Signature of Department Chair: