VRS Questionnaire New

Is the Visitor a citizen or permanent resident of the United States/have a Social Security Number? *

Yes No

If the visitor is a citizen of the United States and has a SSN, the sponsor must initiate a background investigation by requesting the visitor complete the UGA Human Resources Consent to Background Check Form - http://busfin.uga.edu/forms/bi_request.pdf. The completed form is submitted to HR to conduct the background investigation.

The background investigation approval must be uploaded here and submitted with the questionnaire. DO NOT upload the Consent to Background Check form. The Consent to Background Check form is sent to HR.

Please upload the BI APPROVAL or WAIVER from HR. DO NOT upload the Consent to Background Check form. *

If no, country of citizenship *

You have indicated that this person is a non-U.S.citizen/non-permanent resident. He/she will need to have a U.S. visa to come to UGA. Do you plan to request or have already requested sponsorship through UGA's Immigration Services Office? *

Yes No

If no, under what sponsorship will this person be coming to UGA (ie: IREX, Fulbright, independent B-1/B-2 visitor visa, etc.) *

Note about visa sponsorship through UGA: Visa sponsorship is handled through the Office of Global Engagement - Immigration Services. If you have not already done so, contact Immigration Services (IS) to initiate the visa sponsorship process by emailing immigration@uga.edu, or calling 706 542-2900. All scholars must complete a check-in process with IS once they arrive on campus.

Please be aware that most research positions should NOT be conducted under a tourist (B-2) visa. In general, all research positions should be sponsored for a J-1 visa through the Immigration Services (IS) Office. Please contact IS to determine if your scholar requires a UGA visa sponsorship. All scholars must complete a check-in process with IS once they arrive on campus.

A passport number is required to assign the UGAID if the visitor is a foreign national. Please upload a scan of the visitor's passport. *

Visitor Type *

Has this person previously been faculty, staff, a student or visitor on campus? *

Yes No

Please enter the visitor's name and gender exactly as it appears on the visitor's government issued documents (the Driver's License or passport). No nicknames, etc. Please ensure the date of birth is translated correctly from the driver's license or passport. The date of birth should be listed here as MM/DD/YYYY. Some passports list the date of birth in a different format.

Visitor's Given Name/First Name *

Visitor's Surname/Last Name *

Date of Birth *

Month Day Year

Gender *

Male Female

E-mail *

Questionnaires that are submitted with visit start dates earlier than Phase 3 will be returned.

Anticipated Visit Start Date *

Month Day Year

Visit End Date *

Month Day Year

Will this person physically come to one of UGA's campuses/properties? *

Yes, this person will physically come to a UGA campus or property. No, this person will not physically come to a UGA campus or property, but is still participating in UGA research and/or needs access to UGA systems.

Sponsoring UGA Unit *

UGA Department/Unit Head *

First Name Last Name

UGA Department/Unit Head Email *

UGA Faculty Sponsor *

First Name Last Name

Faculty Sponsor's Email *

UGA Staff Contact Person (in the Sponsoring Unit) *

First Name Last Name

Staff Contact Email *

Upon submission of this form, a copy of the questionnaire will be emailed to the unit head, faculty sponsor and staff contact person listed above. The Faculty Sponsor will be asked to reply "Yes" to the email certifying:

1) The information provided in this questionnaire is accurate to the best of his/her knowledge;

2) The Faculty Sponsor recognizes the visiting researcher/scholar will be asked to agree with the statement included at the end of the questionnaire;

3) The unit is willing to host the visiting researcher/scholar described herein, and

4) The Faculty Sponsor understands that as the Faculty Sponsor he/she is responsible for ensuring that the Visiting Researcher/Scholar completes the VRS Onboarding and any required Lab Safety Training (accessed in the Professional Education Portal - PEP).

Is the visiting researcher/scholar employed by ANY entity (university, government, company, etc.) OR ENROLLED in an academic institution? *

Yes No

The employer/institution is a: *

Name of Employer/Institution *

Visitor's title at the institution/place of employment *

Visitor's title type at the institution/place of employment *

Location of Employer/Institution *

UPLOAD SIGNED VISITOR AGREEMENT (pdf file format only). If the visitor is employed with or is enrolled in/associated with any institution the agreement with employer/institution signature must be used and signed by a designated official at the institution/place of employment. Please contact Innovation Gateway if the visitor requests a custom visitor agreement. The blank standard agreements can be found on the VRS webpage here: https://research.uga.edu/visiting/ *

List the campus and building location for the visit (for example, Athens campus in the Coverdell Building). *

Please list the specific UGA systems the visitor will need to access while a Visiting Researcher/Scholar. *

Please select all the activities in which the visitor will be involved while on the UGA campus: *

Research (includes all research activities, whether observing, participating or both, regardless of funding source for the research.) Training and/or Attending classes Presenting a lecture, workshop, seminar, etc. Attending lectures, workshops, seminars, etc. Other. Please explain below.

If Research was selected above, the research is a: *

UGA project funded by internal UGA sources (startup, unit funds, internal grant program, etc.) UGA project funded by external sources (NIH, NSF, a foundation, etc.) Project initiated by the visitor and not funded by UGA and not sources run through UGA. Please specify source below. Other. Please explain below. Multiple sources. Please explain below.

If the research is an externally sponsored project through UGA, provide the following information that is available: Sponsor, PI, Project ID/Portal #, Title of Project. *

If the research is a project initiated by the visitor and is not funded by UGA sources or sources run through UGA, who is the sponsor/source? *

If the funding sources for the research are other or multiple, please explain. *

Please provide a brief statement outlining the visitor's role in the research/activities/work while at UGA. *

0/0

Examples of intellectual property include confidential information, proprietary technology, proprietary tangible materials, and inventions. Access to publications is not included and does not require disclosure below.

Will visitor have access to UGA intellectual property? *

Yes No

Will visitor be involved in the development of intellectual property at UGA? *

Yes No

Will visitor bring any research material and/or background intellectual property with him/her? *

Yes No

If the visitor will bring research material, will the material be co-mingled with any other material developed either by the faculty sponsor or other researcher at UGA? *

Yes No

If the answer to any of these questions is Yes, please describe. *

The visiting researcher/scholar will be required during OnBoarding to certify agreement with the following:

"In your work at UGA, you will be acting on behalf of UGA. As a Visiting Researcher/Scholar, you must follow UGA policies and procedures. In the event of a violation, you may be disciplined up to and including removal from campus. Certain rights do not apply to you as a Visiting Researcher/Scholar, including but not limited to grievance procedures and certain rights of appeal."

Upon submission of this form, a copy of the questionnaire will be emailed to the unit head, faculty sponsor and staff contact person listed above. The Faculty Sponsor will be asked to reply "Yes" to the email certifying:

1) The information provided in this questionnaire is accurate to the best of his/her knowledge;

2) The Faculty Sponsor recognizes the visiting researcher/scholar will be asked to agree with the statement included at the end of the questionnaire;

3) The unit is willing to host the visiting researcher/scholar described herein, and

4) The Faculty Sponsor understands that as the Faculty Sponsor he/she is responsible for ensuring that the Visiting Researcher/Scholar completes the VRS Onboarding and any required Lab Safety Training (accessed in the Professional Education Portal - PEP).

(Instructions on how to certify will be included in the email sent.)

Please enter the word or phrase below before submitting. *

Visiting Researcher/Scholar Questionnaire

Preliminary Qualification

Visitor and Visit Information

Activities of Visiting Researchers/Scholar While at UGA

Intellectual Property

Visiting Researcher/Scholar Certification and Faculty Sponsor Agreement