Date:  January 9, 2006
     Downloadable file:  Word document

Use the link above to download this employee acknowledgement form.

Note that the employee exemption to disclosure requirements is NOT applicable to:
    - Graduate students working as Research Assistants (RAs);
    - Postdoctoral Scholars on J-1 visas;
    - Research staff employed at Stanford under a J-1 visa.

Attach a completed and signed copy to the memo explaining the disclosure of controlled information to a non-citizen (will open in a separate browser window). Send a copy to the University's Export Documentation files
     to: Steve Eisner,    MC: 2064,    email: steve.eisner@stanford.edu
and retain a copy in your departmental project files.
Form for Documenting the Transfer of ITAR-Controlled Information or Software to Foreign Person Bona Fide and Full-time Employees of Stanford University
This Form is in Accordance with the Exemption Provisions of ITAR 125.4(b)(10).
It is NOT applicable to graduate student Research Assistants or researchers on J-1 visas.
Name of Research Project:

 
School or Department:

 
Principal Investigator:

 
Name of DISCLOSING PARTY:

 
Purpose for Which the Information
is Being Disclosed:

 
Transmission method:

 
Transmission date and time:

 
Employee recipient:

 
Recipient's nationality:

 
Recipient's passport number:

 

 

I, __________________________, hereby certify to the following:

  1. I am a full-time regular employee of Stanford University;
  2. My permanent abode throughout the period of my employment at Stanford University is the United States;
  3. I am not a national of a country to which exports are prohibited pursuant to 22 CFR 126.1;
  4. The above-identified information will not be transferred to other foreign persons.

Recipient Signature and Date:   _____________________________________

 

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