Fillable Export Control Exclusion Screening (New Mexico Institute of Mining & Technology)

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Export Control Exclusion Screening (New Mexico Institute of Mining & Technology)

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Export Control Exclusion Screening
Principal Investigator (PI): Answer the following questions and return to the Sponsored Projects Administrator
(SPA) working on your proposal/grant/contract/agreement.
Proposal Ti
tle: PI:
Funding
Agency/Institution: Proposal Number:
Previous # (if co
ntinuation): Est. Start Date:
Fundamental Research Exclusion
Yes
No
Unknown
Will the information be published and shared broadly in the scientific
community?
Are there any proprietary or U.S. government publication or access
dissemination restrictions in the contract?
Are there any restrictions on foreign national participation or requirements for
U.S. citizens only in the contract?
Will there be any foreign nationals and/or persons holding dual citizenship
involved with the project? * Provide the name and nationality of each
individual if known or when available.
Is any of the project equipment export controlled? (If new, describe in
"Additional Information" Section)
Is any portion of the project being conducted at a site other than NMT?
(SubAwardees, Collaborators, Consultants, Other [select one]).
* If “Yes,” Where?
Will items and/or materials be shipped outside the United States?
*
If “Yes,” What? Where? and To Whom?
Is travel outside the US anticipated? * If “Yes,” Where?
Educational Information Exclusion
Is the information commonly taught at schools and universities? (Please see
Export Control Exclusion Screening Tip Sheet for more information.)
Are courses about this information listed in published course catalogs?
Other Terms Mentioned or Discussed Within the Project
d
ocumentation
If “Yes” is indicated, please include a brief description.
Encryption Software? * If yes, fill out the “Checklist for Encryption
Software…” form from the Office of Research - Compliance office
Select Agents? *If “Yes,” What is it?
Trade Secrets?
Sanctioned or Embargoed countries? *If “Yes,” Name?
ITAR (International Traffic in Arms Regulation) or Munitions List? *If yes
EAR (Export Administration Regulations) or Export Control? *If “Yes,”#
*ADDITIONAL INFORMATION
***IMPORTANT NOTICE TO PI***
Consequence of Non-Compliance
Failure to comply with US export control laws can result in severe penalties to the individual that can
include the following: Civil penalties up to $500,000 for each violation; Criminal penalties can be applied
up to $1,000,000 each violation; and/or Imprisonment for up to 10 years.
PI Signature:
Date:
Print PI
Name: Phone/Email:
Received By (Pre Award
SPA): Date:
_______
_______________________________________________________________________________________
For Internal Office Use Only:
Reviewer (Print):
Reviewer signature:
Date:
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Export Control Exclusion Screening (New Mexico Institute of Mining & Technology)

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Completed 24 August 2020

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