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International Affairs

The World at UCR

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Exchange Visitor Restricted Party Screening

Indicates required field
Full Name of Exchange Visitor (Scientist/Scholar):

 

Visa Type

 

Name and address of home institution/organization where the Visitor is currently located (not UCR). *

 

Visitor's Current Position in home country

 

 

(Describe the visitor’s planned research, education and/or training activities at UCR. A project description may be attached to the agreement. Attach a copy of CV and/or other information regarding the Exchange Visitor)

 

 

 

 

Will the Visitor be working in the area of biomedical sciences, computer sciences, space sciences, engineering, or other scientific discipline?


Does the project on which the Visitor will be working on while at UCR involve any Critical and Emerging Technology (CET) as identified by the National Science and Technology Council (NSTC)? See CET list here.*


Does the research agreement (e.g., grant or contract) on which the Visitor will be working restrict or prohibit the participation of foreign persons in the project? *

 

Does the research agreement (e.g., grant or contract) on which the Visitor will be working restrict or prohibit the research team’s right to publish any of the data or research results?

 

In performing the work, will the Visitor be provided access to: *

  • Technical information that has been deemed “export controlled”

  • Sponsor or third-party proprietary or confidential information, materials, or software

  • Encryption source code

  • Equipment specifically designed or developed for military or space applications.

 

By signing, I affirm that I am familiar with the details of the Visitor’s work while at UCR and hereby affirm that the contents of the foregoing are true, to the best of my knowledge, information, and belief. I further understand that failure to accurately complete this certification can result in U.S. government export control violations for which civil and criminal penalties can be assessed against any individual found to have caused or facilitated a violation, and/or against the University of California, Riverside.
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Signature of Academic Sponsor - the name entered here will be considered a signature *
Date *
Phone - include country code and area code *

When this form is submitted, it will be automatically delivered to UCR’s Export Control Office at exportcontrol@ucr.edu for review and approval. Please allow for up to 5 business days for a response.
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Upload the Visitor’s CV
One file only.
4 MB limit.
Allowed types: pdf, doc, docx.
4 MB limit per form.

 

Upload the Visitor’s Passport ID page
One file only.
4 MB limit.
Allowed types: pdf, doc, docx.
4 MB limit per form.
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