The International Students and Scholars office and Education Abroad office are in their new location in the Student Services Building, 2nd Floor.

UCR Campus Building under the sun

Exchange Visitor Restricted Party Screening

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

 

Visa Type

 

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

 

Visitor's Current Position in home country
Visitors Current Position

 

 

What is the purpose of the visit?

(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)

 

How will this visit be funded?

 

Name of Visitor’s Supervisor:

 

State specifically where the Visitor will be working at UCR (buildings/rooms)

 

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

Research Access

 

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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