International Inter-Institutional Agreement (IA) Checklist
Have you attached a copy of the
agreement to this checklist? Yes No
Have potential export control issues
been mitigated or eliminated through discussion with the Office of Research
Compliance? Yes No
Is this a student reciprocal exchange
agreement (REA)? Yes No
If yes, has the
potential partner been vetted by the Office of Study Abroad? Yes No
Is this a faculty exchange agreement?
Yes No
Date:
_________________________________________
Texas State representative requesting
this IA
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 IA at Texas State (How will
the IA contribute to the strategic plans of the department, college, and
university?)
|
|
Brief description of the proposed IA’s goals and the
activities that will achieve these goals
|
|
Indicate how the international entity is a good fit for
the goals identified above
|
|
|
For REAs only - Indicate the specific
strategies and person(s) responsible for maintaining a balance between
incoming and outgoing students |
|
Executive officer who is authorized to
sign the IA on behalf of the international entity
Name
|
|
Title
|
|
Contact information of the coordinator
who facilitates the IA 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 IA? Yes No
List the estimated time requirements or commitments for
the ADP and any other Texas State personnel directly involved in the IA’s
activities
|
|
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 IA? Yes No
Person who is responsible for obtaining
a signature for the IA (if not indicated above)
Name
|
|
Title
|
|
Department
|
|
Phone
|
|
Mailing address
|
|
Budget Form (as applicable)
Source of Funds
|
Description |
$ per year |
Expenses
|
|
|
Salaries
|
|
|
Benefits
|
|
|
International Travel
|
|
|
Domestic Travel
|
|
|
Per Diem’s
|
|
|
Housing
|
|
|
Medical Insurance
|
|
|
Tuition
|
|
|
Consulting Fees
|
|
|
Other
|
|
|
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 (Director, Study Abroad, if applicable) 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:
ü Complete all
relevant sections ü Attach required
documents ü Obtain signatures
in the routing order and forward to the next office ü Retain a copy for
your records ü 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. |