Attachment II

International Inter-Institutional Memorandum of Understanding (MOU) Checklist

 

Have you attached a copy of the MOU to this checklist? Yes No

 

Have potential export control issues been mitigated or eliminated through discussion with the Office of Research Compliance? Yes No

 

Date: ___________________________________

 

Texas State representative requesting this MOU

Name

 

Title

 

Department

 

Email

 

Phone

 

Campus mail

 

 

Person to whom you directly report

 

 

 

 

Contact information of the university representative at Texas State (complete only if different than information provided above)

Name

 

Title

 

Department

 

Email

 

Phone

 

Campus mail

 

 

Information related to the international institution, governmental agency, or non-governmental agency

Name of Institution

 

Address

 

Number of students enrolled annually

 

Academic ranking or quality

 

Mission statement

 

General description and relevance or purpose in the home country (50 words or less)

 

 

Sub-unit, if any, within the corresponding international entity (school, department, etc.)

 

 

 

 

Website address of international entity or entities

 

 

 

 

Rationale for the proposed MOU at Texas State (How will the MOU contribute to the strategic plans of the department, college, and university?)

 

 

 

 

Indicate why you chose this international entity as a prospective partner for a future international agreement (IA).

 

 

 

 

Executive officer who is authorized to sign the MOU on behalf of the international entity

Name

 

Title

 

 

Contact information of the coordinator who facilitates the MOU process at the international entity (the director of an office analogous to the International Office at Texas State)

Name

 

Title

 

Department

 

Phone

 

Mailing address

 

 

Is this person responsible for obtaining a signature for the MOU? Yes No

 

 

Contact information of the university representative at the international institution, if identified

Name

 

Title

 

Department

 

Phone

 

Mailing address

 

 

Is this person responsible for obtaining a signature for the MOU? Yes No

 

Person who is responsible for obtaining a signature for the MOU (if not indicated above)

Name

 

Title

 

Department

 

Phone

 

Mailing address

 

 

Routing and Required Signatures

 

 

 

 

Signature and Approval (Department Chair/Director) Date

 

 

 

Signature and Approval (Academic Dean) Date

 

 

 

Signature and Approval (Director, International Office) Date

 

 

 

Signature and Approval (TSUS General Counsel) Date

 

 

 

Signature and Approval (Graduate College Dean, if applicable) Date

 

 

 

Signature and Approval (Assistant VP for Research) Date

 

 

 

Signature and Approval (Associate VP for Academic Affairs) Date

 

 

 

 

 

Signature and Approval (Provost and VP for Academic Affairs) Date

 

 

 

 

Remember to:

 

  Complete all relevant sections

  Attach required documents

  Obtain signatures in the routing order and forward to the next office

  Retain a copy for your records

  Contact the International Office for any questions (512-245-7966) or email internationalagreements@txstate.edu

 

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 associated with the use of courier services for this service.