Attachment II

Texas State University International Inter-Institutional Agreement (IA) Checklist

Please complete the information in the space provided and forward by email to the International Office at International@txstate.edu.

1	Texas State representative requesting this IA: Name: Title: Department: Email: Phone number: Fax number: Mailing address: Person to whom you directly report:
2	Contact information of the university representative at Texas State (Please complete only if different than information provided above in #1.) Name: Title: Department: Email: Phone number: Fax number: Mailing address:
3	Information related to the international institution, governmental agency, or non-governmental agency Name of Institution: Address: Size (number of students enrolled annually): Academic ranking or quality: Mission statement: General description of 50 words or less and relevance or purpose in the home country:
4	Sub-unit, if any, within the corresponding international entity (school, department, etc.)
5	Web site address of international entity or entities:
6	Brief description of the proposed IA’s goals and the activities that will achieve these goals:
7	Rationale for the proposed IA for Texas State (How does the IA contribute to the strategic plans of the department, college, and university?)
8	Indicate how the international entity is a good fit for the goals identified in # 6:
9	Rationale for the proposed IA for the international entity (How does the IA contribute to the strategic plans of the international entity?)
10	Name and title of the executive (president, rector, etc.) officer who is authorized to sign the IA on behalf of the international entity
11	What is the expected source of funds for this IA? What are the funding requirements estimated for this IA per year? Please use the Budget Form below to answer these questions.
12	Coordinator who facilitates the IA process at the international entity (an office possibly similar to the International Office at Texas State) Name: Title: Email: Phone number: Fax number: Mailing address:
13	List the estimated time requirements or commitments for the APD and any other Texas State personnel directly involved in this IA’s activities.
14	Contact information of the university representative, if identified, at the international institution Name: Title: Email: Phone number: Fax number: Mailing address:
15	Person who will receive this IA and obtain signatures Indicate if it is either #12 or # 14 above. If not, please complete information below: Name: Title: Email: Phone number: Fax number: Mailing address: Note: The use of courier services such as Fedex, DHL or other similar services is strongly recommended when sending IAs to international institutions. The Texas State college, department or office initiating the IA is responsible for costs related to the use of courier services for this purpose.
16	Name and Signature of Texas State Department Head Name and Signature of Texas State Academic Dean

Budget Form
Source of Funds:	Description	$ per year
Expenses:
Salaries
Benefits
International Travel
Domestic Travel
Per Diem’s
Housing
Medical Insurance
Tuition
Consulting Fees
Other