EXPORT CONTROL REVIEW FOR FOREIGN NATIONAL VISITORS

ACCESSING RESTRICTED-ACCESS AREAS AT UTMB

1.Visitor’s name:

2. List all countries in which Visitor resides:

3. List all countries in which Visitor has citizenship:

4. Visitor’s home address:

5. Visitor’s email address:

6. Name and address of Visitor’s

company, university or employer:

7. Visitor will be present from to .

8. Purpose of visit:

9. Is this visit sponsored, approved or financially supported by Cuba, Iran, North Korea, Syria or Sudan, or by any foreign nation’s military? Yes No

10. Will the foreign national visitor work on or have access to any of the following? Yes No

(1) Information, software, or technical data that is not publicly available; (2) Information about how to weaponize or use any items, materials, technical data or equipment for military purposes; (3) Research funded by the Departments of Defense, Energy or Homeland Security; NASA; or any component of the U.S. military; (4) Research or equipment to which access to foreign nationals is forbidden.

11.Did the foreign national visitor’s name produce search results in Visual Compliance?

Yes No My department does not have access to Visual Compliance.

12.Please indicate each restricted-access area to which the foreign national visitor will have access.

13.Is this a late submission for a visit that has already occurred? Yes No

Animal Resource Center / Clay Hall / NMR Dockside Bldg.
Basic Science(s) Bldg. / GNL/Keiller / Research Bldg. #17
Blocker Medical Research / Mary Moody Northern Pavillion / Research Support Bldg.
Brackenridge Hall / Maurice Ewing Hall / OTHER:

If you answered each of Questions 9, 10 AND 11 as “No,” UTMB’s Export Control Officer’s approval is not required before the foreign national visitor is given access to UTMB’s restricted-access areas. If you did not answer each of Questions 9, 10 and 11 as “No,” UTMB’s Export Control Officer’s approval is required before the foreign national visitor is given access to UTMB’s restricted-access areas.

EXPORT CONTROL CERTIFICATION
I have read and understood the attached instructions, and I have completed this form truthfully. I understand my duties that: (1) the Visitor will not receive and/or take any export-controlled equipment or technology from UTMB; (2) the Visitor will be escorted at all times while in any restricted-access building; and (3) the Visitor will depart on the date stated above. I will promptly complete and submit a revised form should any of the answers I have provided need to be revised.
Invitor Name: Invitor Signature: ______
Invitor Department: Date: ______

BACKGROUND

This form must be completed for all foreign national visitors who will have access to UTMB’s restricted-access areas. For this form, foreign national visitors are people who (1) do not have citizenship of or permanent residency in the United States; and (2) are not employees, staff, volunteers or students of UTMB.

UTMB employees and researchers often invite collaborators, scientists or colleagues from other institutions and countries to observe research, give talks and presentations, or substantively participate in research while on UTMB’s campus. While these activities are acceptable and often encouraged, we must comply with export control laws. Disclosure of technical data to foreign national visitors at UTMB may be deemed an export requiring a license from certain U.S. government agencies before disclosure. Additionally, the Department of Treasury, through the Office of Foreign Assets Control, prohibits UTMB from working with or giving anything of value, such as research, to sanctioned individuals on the Specially Designated Nationals List. UTMB employees must observe these laws when allowing foreign nationals to visit or tour restricted-access areas. UTMB and its employees can be held personally and even criminally liable for disclosure of export-controlled technical data to a foreign national visitor.

INSTRUCTIONS

BEFORE ANY FOREIGN NATIONAL VISITOR IS GIVEN ACCESS TO ANY RESTRICTED-ACCESS AREA AT UTMB, the UTMB Invitor and the Invitor’s department shall follow the procedure below.

  1. When any UTMB employee (“UTMB Invitor”) invites a foreign national to visit UTMB’s campus and such visit will include access to a restricted-access area,the UTMB Invitor must promptly notify his or her department and complete this form.
  2. Completing this form requires access to the Visual Compliance database, which allows for the screening of visitors and institutions that might be of concern for export control reasons. Although all departments should have access to Visual Compliance, please contact the Export Control Officer (“ECO”) if your department does not have access ().
  3. All completed forms must be emailed to .
  4. If the UTMB Invitor responds “No” to each of Questions 9, 10 and 11, the UTMB ECO’s approval is not required before the foreign national visits a restricted-access area.
  5. If the UTMB Invitor does not respond “No” to each of Questions 9, 10 and 11, the UTMB ECO’s approval is required before the foreign national visits a restricted-access area. Upon email submission of the completed form to UTMB’s ECO, who will review the form and advise the department whether further action is necessary. In this case, the foreign national visitor must not be granted access to any restricted-access area until approvedby the ECO. The ECO’s response shall be indicated on the first page and returned to the department. The ECO will need at least seven (7) business days to complete the review. If a situation requires expedited review, contact the ECO directly at (409) 772-0376.
  6. The department is encouraged to keep a copy of the form for its records.
  7. If the department learns of a foreign national visitor’s access of a restricted-access area after the visit has occurred, the department must still complete the form (See Question 13).
  8. Departments are encouraged to use Visual Compliance to screen all visitors, whether U.S. citizen or foreign national.
  9. Restricted-access area is defined as (1) a designated location on campus where UTMB personnel engage in research, and entrance to said location requires UTMB badge access, visitation logs, or any other prior identification screening or (2) any location identified by UTMB officials as a restricted-access area.
  • If you have any questions about this form, export control laws or UTMB policy, please contact UTMB’s Export Control Officer Frances Streeter, JD at (409) 772-0373 or .
  • Visit UTMB’s Export Control compliance website at for more information about export control.
  • NOTE: This form is not applicable to service technicians and vendors per UTMB’s Vendor Visitation Policy.

Export Control Use Only
 Approved  Not Approved
ECO Initials: ______Date:______

Revised September 4, 2012