International Guests/Delegations @ FIU - employee request form

International Guests/Delegations @ FIU - employee request form

Requestor: FIU Employee

This form serves to register individual international guests and delegations (multiple guests) who come to FIU for a short-term, explorative visit. Once submitted, FIU Global will assist with making the appropriate arrangements for a productive visit. Requests should be submitted at least 10 business days in advance.

FIU requires that international guests and delegations visiting laboratories, offices and research environments that are considered potentially export-control sensitive and/or have been identified as performing federally sponsored research or services to which certain publication and/or citizenship restrictions apply, be screened through FIU’s Restricted Party Screening (RPS) screening process in advance of such visit occurring.

Upon receipt of this form, FIU Global staff will conduct the RPS promptly and notify you only if any guest or delegation member may need to be restricted from access.

For questions, please email us at global@fiu.edu.

Requestor Information

The requestor also serves as the international guest/delegation primary host. Administrative staff or student assistants should enter the name and contact information of the faculty/administrative host in this section.
Requestor Requestor First Last
This form is for FIU employees only. If you are an international guest or delegation member, please exit this form and use the form for guests/delegation requestors.
Requestor's panther ID number
Must be 7 digits. Currently Entered: 0 digits.
This should be the PID of the responsible faculty/administrator for the visit, not any administrative staff/student assistant.
Title/academic rank (if applicable)
Requestor department

This should be the business unit that proposes the international guest's/delegation's visit and will be the primary unit responsible for hosting and covering any applicable expenses.
Requestor's email address
Requestor's phone number
International Guest/Head of Delegation
Name of individual guest/head of delegation Name of individual guest/head of delegation First Last
Please submit the name and contact information of the person with whom you are in contact and the visit is coordinated. The requestor does not necessarily have to be the highest-ranking official in a delegation.
Title/academic rank (if applicable)
Email of the guest/head of delegation
Phone number of individual guest/head of delegation
International Guest Institution/Organization
Name of international institution/organization

List the institution/organization with whom the individual guest/head of delegation is affiliated. Should there be multiple institutions/organizations represented, please list them in detail below in the Delegation Members section.
Address of international institution/organization Address of international institution/organization
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
The international institution/organization Is

The international institution/organization Is Public Private
The international institution/organization is an affiliated government entity

The international institution/organization is an affiliated government entity Yes No
If the previous answer is YES, please provide the name of the government entity
Brief summary of the international institution/organization
Partnership With FIU
Has FIU had, or still has, an agreement/partnership with this institution/organization?

Has FIU had, or still has, an agreement/partnership with this institution/organization? Yes No
If yes, what type?

Examples are: Dual Degree Agreement, Exchange Agreement, ERASMUS+, Memorandum of Understanding, Pipeline Agreement, Inter-Institutional Agreement etc.
With which FIU department?
Partnership/agreement expiration date?: Partnership/agreement expiration date?: / MM / DD YYYY

If you do not know this, please leave this field blank.
Objective for the Proposed Visit
Is this a first or a follow-up visit?

Is this a first or a follow-up visit? First visit Follow-up visit
If this is a follow-up visit, what year was the first visit?
Maximum of 4 digits allowed. Currently Entered: 0 digits.
Primary purpose for the visit?:

Primary purpose for the visit?: Enhance education or research capacity of an individual department, academic unit, or the broader university (e.g. a guest lecture) Create new learning opportunities for student and/or faculty with this international institution/organization Explore new opportunities for students and/or faculty exchange Exchange knowledge and ideas around topics of mutual interest Discuss/renew potential research collaborations Learn about FIU/exploratory visit Other Other
What is the objective for this visit?
Research/Laboratory Visit

Skip this section if the guest/delegation does NOT plan to visit a research facility/laboratory
Is the visit part of a federally sponsored agreement (grant, contract, CRADA, other)? Or FIU (non-federal sponsored) collaboration?

Is the visit part of a federally sponsored agreement (grant, contract, CRADA, other)? Or FIU (non-federal sponsored) collaboration? Yes No
If yes, please identify:
Will the visitor be permitted to perform any “hands-on” demonstrations or techniques?:

Will the visitor be permitted to perform any “hands-on” demonstrations or techniques?: Yes No
If yes, please describe:
Will FIU be submitting a visa-support application for the proposed guest or any delegation member to come longer-term to FIU?
Will you be demonstrating to the guest/delegation any research capability using instrumentation and/or software that has been identified by the Export Control Office (ECO) or other party as export controlled?

Will you be demonstrating to the guest/delegation any research capability using instrumentation and/or software that has been identified by the Export Control Office (ECO) or other party as export controlled? Yes No
Will the guest/delegation be exposed to any software with cryptographic functionality or cryptographic source code?

Will the guest/delegation be exposed to any software with cryptographic functionality or cryptographic source code? Yes No
Is there any research conducted in the laboratory to be visited by the guest/delegation that would be considered proprietary to FIU, and not otherwise considered fundamental research?

Is there any research conducted in the laboratory to be visited by the guest/delegation that would be considered proprietary to FIU, and not otherwise considered fundamental research? Yes No
Does the laboratory to be visited by the guest/delegation perform any work that is the subject of an Invention Disclosure or patent application pending?

Does the laboratory to be visited by the guest/delegation perform any work that is the subject of an Invention Disclosure or patent application pending? Yes No
Logistics for the Visit
Proposed date for the visit: Proposed date for the visit: / MM / DD YYYY
Alternate date for the visit: Alternate date for the visit: / MM / DD YYYY
How will the international guest/delegation travel locally to FIU?

E.g. by car (requires parking accommodations)
International Guest's/Delegation Member's Entry Authorization

Information on the guest's/delegation's travel documents.
Does your guest/delegation require official letters of invitation from FIU for visa purposes?:

Does your guest/delegation require official letters of invitation from FIU for visa purposes?: Yes No
If yes, list the individual names below:
If applicable, please specify the visa type(s) through which the guest/delegation members will enter (or has entered) the U.S.:

If you don't know the guest's/delegation members' visa type(s), please enter "I don't know".
Delegation Members Information (where applicable)
Please provide detailed information for each member of your delegation [Last name, first name, title, rank. department, institution/organization, e-mail address, and upload biography]:
International guest's/delegation members' bio:

Attach Files
Attestation

If this form is completed by the proxy of the faculty/administrative host, please ...
I hereby acknowledge that I have completed this form to the best of my ability and that the information herein stated is accurate and current.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.