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International Pre-Travel Export Control and Risk Form
Once completed, this form must be attached to the related Pre-Travel Authorization Request in Concur
Travel Request Name:
(30 characters or less)
(required)
Traveler
Name (First Last)
(required)
(Please use same name and spelling as that in your Concur Travel Request)
Email
(required)
(University of Massachusetts email address only)
CC Email (optional)
Enter an email address here if you would like to CC this form to someone else when it's completed
(University of Massachusetts email address only)
Department
(required)
Traveler Type. List all that apply
(required)
Faculty
Employee
Undergraduate Student
Graduate Student
(If you are both an employee and a student, please check both applicable boxes)
Are you traveling with students or a student group?
(required)
Please select...
Yes
No
Describe Student Travel. Please indicate whether you are traveling with undergraduate or graduate students and the type of activities you will engage in. (required)
Do any of your destinations meet the criteria for high-risk destinations as determined by the Systemwide Travel Risk Management Advisory Committee (TARMAC)? Please use the Risk Lookup to check. (required)
Please select...
Yes
No
(
Risk Lookup
)
Most high-risk destinations also meet the TARMAC criteria for
elevated cybersecurity risk
. If that is true of your destination, Research Compliance and/or IT will contact you about options to mitigate cybersecurity risks.
Traveler Contact Information While Traveling
Phone number while traveling: (required)
Email:
Personal Emergency Contact Information:
Name:
(required)
Phone: (required)
Email:
(required)
Export Control/IT Review (required)
Are you traveling with any of the following? List all that apply. (required)
Research materials, specimens or samples
University research equipment (other than University-owned computer, tablet or mobile device)
None
Will you be traveling with a University-owned computer, tablet or mobile device? (required)
Please select...
Yes
No
Does the device contain non-standard, non-commercially-available software (e.g., proprietary, under an NDA or research agreement)? (required)
Please select...
Yes
No
Do any of the following apply to the data (e.g., email, research-related files) you will store or access while traveling? Check all that apply. (required)
Funded by the Department of Defense or its subcontractors
Sensitive information (e.g., FERPA, Protected Health Information, Personally-Identifiable Information) (see links below for additional information)
Proprietary information
Human subjects data
Clinical trials data
Custom encryption software
None (including not storing/accessing University data)
Other data subject to elevated security requirements (please explain)
Please explain "Other data subject to elevated security requirements" (required)
Reference links:
FERPA
|
Protected Health Information
|
Personally-Identifiable Information
Select the methods through which you plan to access such data. List all that apply
(required)
Virtual Private Network (VPN) (preferred for international travel)
Email
One Drive
Other (including not storing/accessing University data) (please explain)
Please describe "Other" data access method(s) (required)
Will you access, discuss, or present data related to a project that is subject to a Technology Control Plan (TCP) or Data Use Agreement (DUA)? (required)
Please select...
Yes
No
Does your travel relate to work on a federally funded project? (required)
Please select...
Yes
No
Please identify the source of funding (e.g., NIH, NSF, DoD, etc.) (required)
High Risk Questionnaire
In-Country Address:
Please list additional ways in which you can be reached, such as social media.
(e.g. email, WhatsApp, We Chat, Instagram, Facebook name, Twitter name, etc.)
If you anticipate being away from regular email or phone contact, please describe how you will overcome such challenges. (required)
Primary Campus Contact:
(Campus Contact should be someone who will be in the United States during your Travel)
Name:
(required)
Phone: (required)
Email:
(required)
Describe your plan for communicating with Campus Contact:
(required)
(Please note: communication should include a minimum of a check-in when you arrive on-site, at least one check-in communication during the program, and preferably weekly check-ins.)
In-Country/On-site Emergency Contact:
(This can be your in-country partner organization(s), collaborator, host organization, placement agency, personal contact, or anyone who will be on-site with you who can be contacted in the event of an on-site emergency. Please list additional partners below if there are more than one contact.)
Name: (required)
Phone: (required)
(Include country code + city code)
Email:
(required)
Personal Safety Plan for High Risk Travel
Describe the academic relevance, purpose, and an overview of planned activities of the program; please include the compelling and urgent reasons for engaging in this project in this location at this time. (required)
Have you traveled to this destination previously?
(required)
Please select...
Yes
No
Describe previous travel experience to this destination, including estimated dates (required)
Describe your ability to speak/understand local/host country language(s). If any language barriers exist, please explain how they will be addressed. (required)
Describe what on-site health, safety, and security support resources and services that are provided by your in-country partner, on-site host, or others. (required)
(e.g., on-site orientations, familiarization tour of area, accompaniment of staff, after hours emergency number, local clinic, evacuation services, emergency protocols, etc.)
Please provide the address of the nearest U.S. Embassy or consulate for each destination, or the location of the closest embassy or consulate for your nationality (if different)
(required)
(
U.S. Embassy lookup
)
Please provide the 911 equivalent at your destination
(required)
(
Lookup 911 Emergency Equivalent Number
)
Risk Assessment and Mitigation
Please consider the following resources for completing the following questions
ISOS Emergency International Assistance Provider Custom Location Reports
U.S. Department of State Country Information Pages
U.S. Department of State Travel Advisories
U.S. Overseas Security Advisory Council Crime and Safety Reports
United Kingdom Foreign Travel Advice
Government of Canada International Travel Advice and Advisories
Australian Government Foreign Travel Advice
Please identify the top risks of your proposed travel and describe how you plan to mitigate these risks. (required)
Describe how accommodations were chosen and/or vetted for safety and security. (required)
Describe the inter-city and intra-city transportation methods you may use and describe safety strategies you will employ. (required)
Please list health risks associated with this destination (immunizations needed, diseases, water quality and potability, on-site medical access and quality, etc.) and describe the mitigation strategies you will employ. (required)
(Please note: the UMass Amherst Travel Clinic can provide vaccinations, recommendations, and individual country reports for University Travelers. However, it is your responsibility to check with a medical professional regarding concerns you may have regarding your personal health, medical conditions and mental health, medications you take, and risks related to asthma or any allergies you may have. Also consider what COVID entry restrictions may exist for travel.)
Describe the risk of natural disasters in the Destination(s) (e.g., earthquakes, tropical storms, flooding, landslides, etc.) and the mitigation strategies you will employ. (required)
Please provide information about potential threats to your personal safety (bodily harm, terrorism, kidnapping, etc.) including any potential for harassment based on identity (nationality or dual-citizenship, gender, LGBTQIA+, race, ethnicity, religion, etc.) (required)
Please describe possible political or civil unrest (upcoming elections, history of demonstrations, political instability, etc.) and describe the mitigation strategies you will employ. (required)
Describe the risk(s) associated with other potential high-risk activities (e.g., high altitude, physical activity, hiking in remote areas, swimming, project involving human subjects, research topics that can be perceived as politically sensitive or contentious, traveling to a country under US sanctions, ethical considerations for global health projects, etc.) and describe the mitigation strategies you will employ. (required)
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