I-129 Review Form (Editable)

Federal regulations for visa applicants of this type require UNM to certify that the employee or prospective employee either: (1) will not be involved in any activity that would require an export control license or (2) will be involved in an activity requiring an export control license and UNM will prevent access to controlled technology until an export control license has been obtained. The purpose of this questionnaire is to assist the export control office in making that determination.

This questionnaire must be completed by an individual knowledgeable about the applicant's work assignment, including the technical nature of the work and the source of financial support. Please electronically fill out the following form (you do NOT need to print this form) and email it to your export control office (please select your office below)

☐Main& Branch Campuses: , 277-2968 ☐HSC: , 272-5993 / 272-8675

Applicant Name: / Dept.
Country(ies) of Citizenship: / Country of Legal Residency:
Visa Type:
  1. Applicant’s duties will be (mark all that apply):

☐Administrative ☐ Research ☐ Teaching ☐ Technician ☐ Clinical Medicine/Patient Care

☐ Other, please specify:

  1. Please describe the work and/or activities to be performed by the applicant. Please include the applicant’s specific area of expertise and if applicable all areas of research and any type of technology on which the applicant will work, be as specific as you can:
  1. Will the applicant participate in any scientific research?

☐Yes ☐No, skip to Question 8 ☐Possibly, in a future undefined project, Skip to Question 5

  1. Provide the following information for each research project in which you know or anticipate the applicant will participate (if more than 1 project please include additional information in an email to or ):

PDS/HSC ID#: Proposal Title:
PI: / Job of Applicant:
Sponsor: Labs and work areas:
  1. In which type of research will the applicant participate (mark all that apply):

☐Basic ☐Applied ☐Advanced ☐Development ☐Testing Service Oriented ☐Other:

  1. Will the applicant participate in any research under a contract or grant that restricts certain non-U.S. persons from participating in the research or assessing the research results? ☐Yes ☐No ☐Possibly in a future project and I will contact the HSC or Main campus export control office before applicant begins work on such a project
  1. Will the applicant participate in any research under a contract or grant that restricts publication or dissemination of research results? ☐Yes ☐No ☐Possibly in a future project and I will contact the HSC or Main campus export control office before applicant begins work on such a project
  1. Will the applicant have access to high-tech, experimental equipment, or prototypes (examples would be high speed computers, sensors, materials, electronics, lasers telecommunication devices or other cutting edge equipment)? ☐Yes ☐No
  1. Will the applicant have access to (including participating in the development of) materials, equipment, software, or technology specifically designed, developed, configured, adapted, or modified for space or military applications? ☐Yes ☐No
  1. Will the applicant be exposed to encryption software source code, or otherwise be involved in the design, development, or production of encryption software? ☐Yes ☐No
  1. Will the employee or prospective employee perform ALL of the following functions for any research equipment: operation, installation, maintenance, repair, overhaul, and refurbishing? ☐Yes ☐No

I certify that the information provided is true to the best of my knowledge, and by clicking yes I agree to inform the Export Control Office before the prospective employee moves to a different laboratory or begins work in a setting outside of my control or knowledge.

☐Yes, I agree

Your Name:

Internal Use Only

☐Visual Compliance check

☐Cornerstone check

☐Option 1 of Part 6 of the I-129 form should be checked. Based on the above responses it is not anticipated at this time that the university position offered to this applicant will require a license for release of controlled information

☐Option 2 of Part 6 of the I-129 form should be checked. The position offered to the applicant has the possibility to require a license because of exposure to controlled information but no specific project has been identified.

☐Option 3 of Part 6 of the I-129 form should be checked. A license is required for this applicant.

☐An export license has been obtained. License reference:

☐A license exception or exemption is applicable. Exception / exemption used:

☐An export license application is in process. Until the university receives a valid license from the appropriate government agency, the hiring unit will adhere to a technology control plan approved by the UNM Export Control Office.

Reviewed by: Date:

As of 8/10/20168/9/2016