EXPORT CONTROL WORKSHEET
(TO BE FILLED OUT AND PROVIDED TO OSP BEFORE EXPORTING)
OSP, Attn: Carol Rhodes, Export Control Specialist, BOX 359472 or carhodes@u.washington.edu
GC-1 # or Budget # if applicable:________
Your name and contact info._____________________________________________________________
Description/Quantity of Item
Describe Item/Software/Technology to be Shipped or Transmitted:
If applicable, list the quantity of the Item/Software/Technology:
If available, please list the manufacturer's number, obtain the Export Control Classification
Number (ECCN) from the manufacturer, or attach the manfacturer's description of the item:
Is the item of U.S. origin or is it foreign-made with U.S. parts, components, or materials or using
U.S. technology?
Destination of Item/Software/Technology
Ultimate Country of Destination of Item/Software/Technology:
Will Item/Software/Technology be shipped to other destinations before reaching ultimate
destination?
Where is Item/Software/Technology presently located?
End-User and End-Use Information
Please identify the person/organization/institution/entity (end-user) receiving the
item/software/technology:
For what purpose does the end-user need the item/software/technology?
To your knowledge, is the end-user undertaking activities specifically prohibited by the export
control regulations (proliferation of nuclear weapons, chemical or biological weapons, missile
technology)?
If you have questions, please contact Carol Rhodes, Export Control Specialist, University of Washington Office of
Sponsored Programs at (206) 543-2139