Youngstown State University Un Office of Research Services Youngstown State University Office of Research Export Control Approval Form This electronic form complies with the U S Department of Health and Human Services Section 508 accessibility requirements for online PDF files If you need assistance completing this form or would like to provide feedback to help improve this form, please contact us Research interests conducted abroad by YSU personnel (students, faculty, staff, and administrators) have the appropriate institutional approval and, as required by Federal laws, appropriate certifications and licenses YSU researchers (U.S citizens as well as foreign persons living in the U.S.) must remain in continual compliance with Federal regulations and remain cognizant of security issues that have potential to compromise research To min-imize risk, YSU researchers must submit a request for Export Control Approval to the Office of Research prior to any communication, travel, signing of contracts, or transmissions of research Principal Investigator: College: Department: Funding Sponsor: Country(ies) Involved: Project Title and/or Purpose: Data, Goods, and/or Services Involved: Does the research involve any item(s) listed on the Commerce Control List or U.S Munitions List? If so, please identify Are you transferring technology, blueprints, media, research results or other information or data to any foreign individual or agency? Will your work require completion of a Mutual Non-Disclosure Agreement? Please Select Are you traveling to any site on the Treasury Sanctioned Countries list? Please Select Are any persons or entities involved in the project listed in the U.S Consolidated Screening List?Select Are you taking any YSU owned data, supplies, or equipment abroad? Please Select As identified in NSDD-189, will your research data and materials be accessible and available publicly (non-commercial and entirely research based)? Please identify: I hereby certify that my answers are complete and correct to the best of my ability and acknowledge that I have cross-referenced all individuals and entities on all of the above restriction lists ORS 3.0 Effective 09/15/2017 Page of