EXPORT CONTROL QUESTIONNAIRE

Please answer the following questions with regard to all research (existing and potential) and other activities in which the research fellow/visiting scholar will be involved. Use a separate page as necessary for detailed explanations.

Name of fellow/visitor

Country of Citizenship

  1. What is the nature of the research and/or other activities in which the fellow/visitor will participate?
  1. Will the research fellow/visiting scholar be using any scientific equipment or instruments that are not commercially available? If yes, please explain the equipment and its location in detail.
  1. Will the research fellow/visiting scholar need to understand how any of the scientific equipment he/she will beusing is designed, manufactured or repaired in order to perform his/her duties? If yes, explain in detail.
  1. Will the research fellow/visiting scholar be exposed to any equipment that was specifically designed or developed for military or outer space application? If yes, please explain the nature of the equipment in detail.
  1. Will the research fellow/visiting scholar be exposed to encryption software in source code or object code or otherwise involved in the design, development or production of encryption software? If yes, please explain in detail.
  1. Will the research fellow/visiting scholar have access to any third-party owned or controlled technical data or technology that is considered proprietary to the third party? If yes, please explain in detail.
  1. Will the research fellow/visiting scholar be working with experimental equipment or prototypes? If yes, please explain in detail, including who owns the experimental equipment or prototypes and the nature of the funding for the research.
  1. If the research fellow/visiting scholar will be involved with any sponsored research projects, you must review the funding research agreement for each project the research fellow/visiting scholar will be involved with and answer the following question for each:
  2. Does the research agreement permit you to publish the results of the study?
  3. Does the research agreement in any way restrict the involvement of foreign nationals in the research?
  4. Is there any language in the research agreement about export control regulations?

(Please provide a copy of any funding research agreement that contains publication restrictions, or language regarding foreign nationals or export control regulations.)

  1. Will the research fellow/visiting scholar have access to any information that was provided to the University under a confidentiality agreement? If yes, please explain and provide a copy of the confidentiality agreement.
  1. Will the research fellow/visiting scholar have access to any materials that were provided to the University under a material transfer agreement? If yes, please explain and provide a copy of the material transfer agreement.
  1. Will the research fellow/visiting scholar have access to and/or use any human pathogens/toxins, animal pathogens/toxins, plant pathogens/toxins in his/her activities at the University? If so, please list:
  1. Will the research fellow/visiting scholar have access to and/or use any item or agent on the attached United States Munitions List (a copy of which is attached) in his/her activities at the University? If so, please list:
  1. Will the research fellow/visiting scholar be involved only in basic and applied research in science and engineering, the results of which will be published and shared broadly within the scientific community? If no, please explain what other type of research the fellow/visitor will be involved with.
  1. Will the research fellow/visiting scholar be involved in any proprietary research or industrial development, design, production and/or product utilization the results of which are restricted for proprietary or national security reasons? If yes, please explain the research, including the funding source.
  1. Will the research fellow/visiting scholar participate in any activities related to or that could affect the following either in the United States or abroad:
  1. chemical and biological weapons proliferation Yes____ No____
  2. nuclear proliferation Yes____ No____
  3. national security Yes____ No____
  4. missile technology Yes____ No____
  5. regional stability Yes____ No____
  6. crime control Yes____ No____
  1. Will the research fellow/visiting scholar be permitted to ship or physically carry any items or information out of the United States as part of the fellow’s/visitor’s activities at the University? (If yes, explain in detail what items or information will be sent/carried out of the country and the destination)
  1. If the research fellow/visiting scholar will be involved in non-research activities, will the activities be:
  2. Clinical activities (explain activities)
  3. Education (i.e., attending public or catalog lectures) (explain activities)

Completed by:

Signature

Name

Date

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