The code block below illustrates how one might use # and // as comments in your logic and calculations.

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This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

dcaJNWNF4UweXQ9LaEmbnvIFZsbBRRIIf9ucgjqcwf6Sb9sC8WuZTe8moD4znosaCwDMgIvFMQ7R8TwQXtXkAAG5V9KmsLCg7JA8jdx4ZP28RgyEwIMeFXVPcv

International Shipping Form

The purpose of this International Shipping Form is to identify any international shipment, which requires prior export control authorization from U.S. Government export authorities and/or special U.S. Customs filing.

Items that can ship without review/approval

Please note that the following items can ship without review/approval unless you are 1) shipping to Iran, Syria, Cuba, North Korea, the Crimea Region of Ukraine, or a restricted or prohibited party in any country; OR 2) the value of your shipment exceeds $2,500. Several operational and business units across Emory can screen activities against restricted or prohibited party lists. If you need help in screening your shipment recipient, please contact the Export Control Office (exportcontrol@emory.edu.)

Basic laboratory supplies (test tubes, beakers, etc.)
Basic office supplies
Personal items such as clothing, toiletries, beauty products, etc. Textiles
Household goods
Promotional items (ex. cups, pens, folders, sweatshirts)
Food products
Artwork and artifacts
Currency
Documents containing published/publicly available technical data or non-technical data

Please complete this form as fully as possible. Questions should be directed to the Export Control Office (exportcontrol@emory.edu).

Requestor Information

1. Requestor Name

* must provide value

2. Request Date

* must provide value

3. Requestor School

* must provide value

4. Requestor Department

* must provide value

5. Requested on Behalf Of (if applicable)

6. Sponsored Project Code/EPEX Number (if applicable)

Recipient Information

7. Name of Recipient

* must provide value

8. Recipient Company/Institution/Organization

* must provide value

9. Street Address

* must provide value

10. Address Line 2

11. City

* must provide value

12. State/Province/Region

13. Postal/Zip Code

* must provide value

14. Country

* must provide value

15. Has the recipient(s) been screened through Visual Compliance?

* must provide value

Yes

Do not know

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Item Description

16. Please include a detailed description and the quantity of the item(s) that will be shipped. If you know the manufacturer and model name of the item, please include it in the description.

* must provide value

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16a. For shipments that include multiple items, please attach a complete list of items in a Word or Excel document. Please include item descriptions, links to the items on the manufacturer/supplier website, quantities, and values in U.S. dollars.

Upload file

17. Please check any of the following that will be included in the shipment.

* must provide value

Laboratory instruments

Tools of a specialized mechanical nature

Samples/prototypes, including fabricated materials

Biological materials or specimens

Specialized scientific software (not including operational software such as Microsoft Office, Adobe, etc.)

Software programs containing or constituting specialized cryptographic functionality (not including routine commercial laptop cryptographic protection)

Technical data related to any of the above

18. Does the shipment contain Hazardous Materials or controlled biologics?

* must provide value

Yes

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18a. If you answered Yes to Question 18, please explain.

18b. Have you received approval from the Environmental Health and Safety Office (EHSO) to ship the items to the intended recipient?

* must provide value

Yes

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19. Does the shipment require an executed Material Transfer Agreement (MTA) prior to shipment?

* must provide value

Yes

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19a. Have you contacted the Office of Technology Transfer (OTT) to begin the MTA process?

* must provide value

Yes

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20. Please identify the export control classification(s) of the item(s) in this shipment. This/these would be either the Export Control Classification Number (ECCN) or U.S. Munitions List (USML) category. If you do not know, please write "Unknown".

* must provide value

21. What is the recipient's intended use of the item(s)? Please be specific.

Examples:

My collaborator in the Netherlands will use the biological material to conduct laboratory research as part of our ongoing project.
These office supplies will be used to support day-to-day administrative tasks at the research site in India.
We are donating laptops to a charitable organization who will distribute them to local secondary schools.

* must provide value

22. Is the recipient a member of a foreign government, military, intelligence agency, and/or police unit?

* must provide value

Yes

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23. Will the export be permanent or temporary (i.e., will be returned to the U.S.)?

* must provide value

Permanent

Temporary to be returned within one year

Temporary to be returned after more than one year

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24. Will the recipient send the item(s) to a different final recipient either in the same or different country?

* must provide value

Yes

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24a. If you answered Yes to Question 24, please explain.

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25. What is the estimated value of the shipment in U.S. dollars (provide exact if possible)?

* must provide value

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