Attachment IV

Request for Additional Action to Existing MOU or IA

 

If continuing the agreement: Have you attached a copy of the revised MOU or IA to this checklist? Yes No

 

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

 

Date: _____________________________________

 

Texas State Institutional Representative

Name

 

Title

 

Department

 

Email

 

Phone

 

Campus mail

 

 

Existing MOU or IA

Title/Entity

 

 

 

 

Action Requested (check and complete one or more sections as needed)

 

1.   Extend the duration of existing MOU or IA

 

Evidence of success with existing agreement:

 

Plans for the future:

 

 

Attach copy of document with track-changes and/or written edits

 

 

2. Add substantive addendum to existing MOU or IA

 

Evidence of success with existing agreement:

 

Plans for the future:

 

 

Attach copy of document with track-changes and/or new addendum

 

3. Make minor edits to existing MOU or IA

 

Rationale for edits:

 

Attach copy of document with track-changes or written edits

 

 

4. Terminate existing MOU or IA

 

Rationale for termination:

 

 

Perspective of international partner:

 

Date of termination:

 

 

Attach copy of communication with partner, if available

 

 

 

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:

 

  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.