Export Control Review Request

PI/Initiator Full Name

Department

Email

Phone

Activity Type

Description of Foreign Activity Type

Project Start Date

Project End Date

Review Checklist

Note: all questions are required

Does your project:

1. Involve travel or transporting data, materials, equipment, software or technology to a foreign country during the course of the project? Yes No

2. Restrict project participation (faculty, student, others) based on country of origin or citizenship? Yes No

3. Involve specific access and dissemination restriction (e.g., restriction of participation by foreign nationals, or restrictions of publication including reporting of research results) or restriction of presenting at conferences? Yes No

4. Involve equipment, software, chemicals, bio-agents, or technology designed or modified for military use? Yes No

5. Involve research containing source code for encrypted software (other than publicly available software)? Yes No

6. Include funding from an external sponsor? Yes No

If you answered NO for question #6, please continue to question #11, otherwise please answer the following questions:

7. Involve a foreign sponsor? Yes No

8. Involve a sponsor that is a defense agency or contractor? Yes No

9. Sponsor Name

10. Award ID#

11. Involve the PI or any research personnel providing data, services, conducting transactions or traveling to embargoed/sanctioned countries? Yes No

12. Will your project involve activities by a UMass Chan employee and/or UMass Chan contracted party in a foreign country? Yes No Maybe

See list of sanctioned countries List: http://www.ustreas.gov/offices/enforcement/ofac/programs/

See the Department of State Country Policies and Embargoes List: http://www.pmddtc.state.gov/embargoed_countries/index.html

Certification

I certify that I understand and will comply with all applicable export control laws and regulations as described at: http://www.bis.doc.gov/licensing/exportingbasics.htm

I Agree

Expert Control Review Request

Review Checklist

Does your project:

If you answered NO for question #6, please continue to question #11, otherwise please answer the following questions:

Certification