DOES YOUR PROPOSAL INVOLVE: / YES / NO
  1. Foreign national participants at CSM?

  1. Foreign travel?

  1. Foreign sponsors or collaborators in another country?

  1. Research for military use or testing?

  1. Encryption software or technology?

  1. Research on weapons or missile technology?

DOES YOUR CONTRACT OR AWARD INCLUDE: / YES / NO
  1. Shipping or transmitting materials, technical data, or equipment outside of the U.S?

  1. Any exchange of classified, restricted, sensitive, export controlled (ITAR/EAR), or proprietary information?

  1. Sponsor publication restrictions or sponsor pre-approval rights over publications?

  1. Any export control language or clauses?

  1. Restrictions on participation of foreign nationals?

  1. Any national security controls?

  1. Receiving export controlled information from the sponsor for use in the research?

If you answered YES to any of the questions, complete Page 2 and contact ORA schedule an export review appointment and receive guidance. Please attach the project summary/abstract to this form and send both by email to ORA.

If you answered ALL NO, complete the Exclusion Checklist on page 2 and keep completed forms with your project file. Review annually and update when changes occur.

I HAVE READ THE FORMS AND THE RESPONSES, AND I AGREE THE INFORMATION PROVIDED IS ACCURATE AND COMPLETE. I WILL UPDATE THIS FORM WHEN CHANGES TO THE RESEARCH PROJECT OCCUR THAT WOULD AFFECT MY ANSWERS AND WHEN NEW PERSONNEL ARE ADDED.

See definitions at: Export Control Regulations at:

Administration Regulations)

(International Traffic in Arms Regulations)

Sign Below:

PI Signature / Date
ORA Signature / Date

PRINCIPAL INVESTIGATOR EXPORT EXCLUSION CHECKLIST

PUBLIC DOMAIN EXCLUSION: / YES / NO
Is the information or software involved in your research published and generally accessible to the public through one or more of the following?
  1. Publication in periodicals, journals, books, print, electronic, or any other media available for general distribution to any member of the public
  2. Subscriptions that are available without restriction to any individual who desires to obtain or purchase the published information
  3. Websites available to the public free of charge or at a cost which does not exceed the cost or reproduction and distribution
  4. Libraries open to the public, including most university libraries
  5. Patents and open (published) patent applications
  6. Instruction in general science, math and engineering principles commonly taught at schools, colleges, and universities and conveying information through courses listed in course catalogues, in associated teaching laboratories of academic institutions
  7. Release in an open conference, meeting, seminar, trade show, or other open gathering in the United States, which is generally accessible by the public for a fee reasonably related to the cost and whether attendees may take notes and leave with notes.

FUNDAMENTAL RESEARCH EXCLUSION: / YES / NO
Does the information or software involved in your research meet allof the following criteria?
  1. Results from basic and applied research in science and engineering conducted at an accredited institution of higher education located in the United StatesAND

  1. Is ordinarily published and shared broadly within the scientific community AND

  1. Is not restricted (either by written agreement or by informal understanding) for
  • proprietary reasons ( publication restrictions)
  • specific national security controls
  • specific U.S. Government access and dissemination controls (restriction of foreign participants).

EDUCATIONAL EXCLUSION: / YES / NO
Is the information commonly taught at schools and universities? AND
Are courses about this information listed in published course catalogs?

If your research or activity does not fall under one of the above exclusions, or you are unsure if an exclusion applies, contact ORA for guidance. Otherwise, keep both checklists with project file.