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Export Control International Travel Form

Name

Country Destination(s)

Will you be transporting (either through carry-on luggage or checked bags) laboratory instruments, tools, samples, raw materials, or prototypes?

Yes
No

If you answered "Yes" above, describe the items, their purpose, and whether you will be bringing all such items back to the U.S. with you or whether some items will remain or be consumed there.

Will you be traveling with a portable electronic device containing proprietary data; confidential or export controlled (i.e., data associated with an export-restricted research project that you have been or are working on currently, even if such data has nothing to do with the purpose of your immediate travel)?

Yes
No

If you answered "Yes" above, describe the nature of the data.

Will you be transporting any device that incorporates specialized scientific software (not including typical operational software such as Microsoft Office, Adobe, etc.) or software programs containing or constituting specialized cryptographic functionality (not including routine commercial laptop cryptographic protection)?

Yes
No

If you answered "Yes" above, describe the nature or type of specialized software (source or executable code, etc.)

Will you be providing any specific training or technical assistance to another individual, entity, or governmental institution (or representatives) beyond scientific collaboration in fundamental research?

Yes
No

If you answered "Yes" above, describe the scope of activity, who will be the recipient, and whether to the best of your knowledge, the recipient is or represents a military/defense organization or function.

Are you planning to engage with an institution or organization for any purpose including but not limited to research, product development, consulting, or provision of services with whom Syracuse University does not currently have an inter-institutional partnering agreement or Memorandum of Understanding (MOU) in place? If you are not certain, please answer "Yes."

Yes
No