International Relationship Proposal Profile

YALE PROPONENT

• Faculty Member Name:
• Department:
• School:


    Contact information:

• Email:
• Phone:
• Address:


    Business Manager:

• Email:
• Phone:
• Address:

FOREIGN UNIVERSITY OR OTHER ENTITY ("FOREIGN ENTITY"):

• Faculty Member Name:
• Department:
• University or Institution:


    Contact information:

• Email:
• Phone:
• Address:


    Administrative Contact:

• Email:
• Phone:
• Address:
• Description of Foreign Entity:

TITLE / NAME OF PROPOSED UNDERTAKING

NATURE AND RATIONALE OF THE PROPOSED (Brief Description)

      Check applicable:
      Student Exchange           Short-term (under 2 years) research collaboration
      Faculty exchange            Long-term research collaboration
      Conference                     Other (explain):

      If research:   Human Subjects: Yes   No
                            Clinical Component: Yes   No
                            Lab Animal Use: Yes   No

      New       Continuing

IS THE PROPOSED RELATIONSHIP A SPONSORED PROJECT?   Yes   No
If yes, have you also or will you also prepare and submit a GCA Proposal Summary and Certification Form?   Yes   No

CONTEMPLATED SHIPMENT OF EQUIPMENT OR MATERIALS

• Type and Amount of Equipment or Materials
• Origin
• Destination

PROPOSED TERM OF THE RELATIONSHIP

      Start Date:   End Date:

OVERALL PROJECT BUDGET

EXPECTED FINANCIAL AND OTHER RESOURCE COMMITMENT

• Yale
• Foreign Entity
• Other Source

EQUIPMENT AND FACILITIES NEEDED

• At Yale
• At Foreign Entity (owned/leased by Yale)
• At Foreign Entity (not owned/leased by Yale)

PERSONNEL COMMITMENT (including undergraduates, graduate students, other faculty (include names), researchers, others)

• At Yale
• Identify any School other than the Faculty Sponsor's School that are involved
• At Foreign Entity

DO YOU WISH TO:

• Hire individuals for work abroad?   Yes   No
• Lease space abroad?   Yes   No
• Lease or purchase vehicles for use abroad?   Yes   No
• Send Yale employees to work abroad?   Yes   No

POSSIBLE EXPORT CONTROL ISSUES

• Will the proposed undertaking involve the transfer or provision of any materials, equipment, or supplies outside of the United States?   Yes   No
• Does the proposed undertaking involve travel, shipment or provision of funds or services to countries or entities under an OFAC sanction program>?   Yes   No
• Will the proposed undertaking contain any controls or limitations on publication or restrictions on non-U.S. citizen access/participation?   Yes   No


• PARTICULAR ISSUES TO NOTE:

YALE INTERNAL REVIEW: As of the date of faculty member's signature (below), has faculty member consulted with the following office, and if so, with whom? (NOTE: Prior consultation is not required.)

• Chairperson of Department   Yes   No   
• Dean's Office   Yes   No   
• Office of International Affairs   Yes   No   
• Provost's Office   Yes   No   
• Grant & Contract Administration   Yes   No   
• Office of General Counsel   Yes   No   

FACULTY MEMBER ELECTRONIC SIGNATURE   

DATE OF SUBMISSION