Visiting Researcher Questionnaire

Hosting Unit

What department/center is hosting this visitor?*

Department/Center Head:*

First Last

Department/Center Head Email:*

Please upload the department/center Head's approval documentation.

Upload a copy (.doc or .pdf) of written confirmation (email is sufficient) from the Department/Center Head that they approve the visit.
*This step is optional during the pilot phase, but will be required beginning 9/15/23.

Accepted file types: doc, pdf, Max. file size: 64 MB.

The Individual Host

The individual host is the university employee who is inviting the Academic Research Visitor and will be primarily responsible for the academic visitor.

Individual Host Name:*

First Last

Individual Host Email:*

Does the Individual Host have a financial Interest or relationship with the Visitor's Home Institution/Employer?*

No
Yes

Provide Detail*

Does the Individual Host currently have a Technology Control Plan overseen by the Export Control Office in SPARCS? If so, what is the related RADAR Record?*

No
Yes

What is the related RADAR Record?

Office Support Contact (If applicable)

If someone other than the Individual Host is completing this questionnaire, please include your contact information

Office Support Contact Name:

First Last

Office Support Contact email:

Visitor

Visitor Name:*

First Last

Visitor's Country of Citizenship:*

US Citizenship or US Permanent Residency
Foreign

Visitor’s Country of Citizenship:*

Visa Type:*

Visitor’s Current Address:*

Please provide entire address, including country.

Visitor’s Home Institution/Employer:*

Country of Visitor’s Home Institution/Employer:*

Upload Visitor’s CV*

Accepted file types: doc, pdf, Max. file size: 64 MB.

Visit Details

Proposed Start Date:*

Proposed End Date:*

Source of Funding for Visitor*

Check all that apply.

NC State Funding
The Visitor's Government
Personal Funds
Other

Include University Project/Account Number:*

Please specify the applicable Agency, Program, etc.*

Please list "other" funding source:*

Proposed Visitor’s Research Activities*

Characterize the research being performed (basic, applied, product development, testing, etc.).

Will the Visitor work on a sponsored project?*

No
Yes

Provide university project/account number:*

Will the Visitor need access to confidential/proprietary data and/or information subject to a Data Use Agreement?*

No
Yes

Please provide identifier of the Data Use Agreement (DUA).*

Primary Work Location

On-Campus
Virtual
Other

On-Campus Location*

Building Name Room Number

Other Work Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

In addition to the Primary work location, please specify any additional university labs or facilities the visitor will need to have access.

Is there any other NC State agreement in place or in process related to this visitor's proposed activities?*

(e.g. Lab/space use agreement, Testing Services Agreement, etc.)

No
Yes

Please provide details.

Include what university office is handling, what type of agreement it is and any relevant identifier.

Comments

This field is for validation purposes and should be left unchanged.