Travel Disclosure Form

This form should be completed by faculty or staff intending to travel outside of the United States during the course of their work, transporting items/software/data/technology. The policy also applies to a foreign person in the U.S. or working with foreign persons, educational institutions, or businesses that might be subject to sanctions. This form is to be completed once, and kept on file in the Office of the Dean of the Faculty.

Legal Name:*
Email*
Phone*
Department/Program*
What is your citizenship?*
Dates of Travel*
Will you be working with foreign persons, faculty or students, educational institutions or businesses while traveling for your research or employment?*
Will you be transporting any encrypted software/technology/items/data to a foreign country?*
If yes, please describe the software/technology/items
Will you be transporting any college-owned equipment to a foreign country?*
If yes, please list the equipment (e.g., laptop, computer, cell phone, GPS).
Your signature below indicates that you understand that you are responsible for any risks or responsibilities related to export control or safety during the specified travel, and that you agree to: --abide by export control guidelines; maintaing effective control over the item; use secure internet connections; utilize personal firewall protection and password protect any files that contain controlled technology; and ensure the device contains no mass market 64-bit encryption software or other encryption capabilities restricted under EAR.*
Date*
MM slash DD slash YYYY
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Comments
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