Form ITA-4143P-3 SABIT Alumni Success Story Report

OMB Control No.: 0625-0225
Expiration Date: xx-xx-20xx

Form No. ITA-4143P-3

SABIT Alumni Success Story Report
Participant Information:
Name:
Program Participation, Year:
Organization and Title:
Work Address, including Postal Code:
Work Telephone:
Mobile Phone:
E-mail:
Can report be used publicly?

Yes

No

Maybe

If alum has given a presentation, please give the following information:
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•
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Location:
Subject:
Number of Attendees:
Other Information:

Type of Success Story (Check all that apply):
 U.S. Exports, Contracts w/ U.S
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Companies
Distribution or Representation
Joint Venture or Licensing
Business Growth (increased revenues or
staffing)
Opening a New Company/Organization
Implementation of New Concepts
Product Registration
Standards and Certification
Participation in the Legislative Process

Success Story Narrative (complete below):

 Improvements in Business Environment
 Election/Appointment to Political
Office

 Promotion/New Position of Greater






Responsibility
Association Activity or Expansion
Conferences or Publications
Scientific Agreements and Joint Work
Business Relationships Between
Alumni
Other

OMB Control No.: 0625-0225
Expiration Date: xx-xx-xxxx

Guidelines for Success Story Reports:
Required Information for Each Report:
Participant Information must be filled out COMPLETELY, no exceptions.
Required Information for Success Story Types:
U.S. Exports and Contracts with U.S. Companies:
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What was purchased and the dollar amount;
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U.S. Company name and location;
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When were the goods/services were purchased?
Distribution and Representative Offices:
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U.S. and alumni Companies involved;
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Location of office(s);
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Products and services represented and/or distributed;
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Dollar amount of products and services represented and/or distributed;
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When was the agreement was concluded?
Joint Ventures and Licensing Agreements:
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Names of U.S. and alumni companies involved;
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Products and/or services involved;
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Status of agreement (has production started? Offices opened?);
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Dates and timeframes.
Business Growth:
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Increase in staff hired (expressed numerically) AND/OR
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Increase in revenues (expressed numerically or by percentage);
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Timeframe for increased staffing/revenues (year on year? Since Internship?);
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New markets and contracts, domestically and/or foreign, leading to growth.
Opening a New Company:
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Alumni involved, name of company and what it does. Where is it located?
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When was company opened?
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Size of company?
Implementation of New Concepts:
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Should usually be checked in conjunction with another theme – and should
usually be a contributing factor in the other part of the success.
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Must be named. No more vague “concepts”. Could be business plans or
strategic plans seen, manufacturing techniques or equipment, but MUST be
specific.

Product Registration:

OMB Control No.: 0625-0225
Expiration Date: xx-xx-xxxx

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What product, when it was registered;
With whom was it registered? Name the registering body.
What was the result of the registration? Have there been sales as a result?

Standards and Certification:
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Did alumnus develop a new standard, or revise an old standard?
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What is the standard, and which industries and products does it cover?
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Did the standard improve (make easier) the certification process?
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When did it go into effect?
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Have there been U.S. companies that have used the improved
standard/certification process to bring their products on to the market?
Participation in the Legislative Process:
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Context – working group, advisory committee, or other;
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What was the law;
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Is the law under consideration, or has it been passed;
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What is the name of the bill or the law? What industries does it affect?
Election/Appointment to Political Office:
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Date of election/appointment
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Full title of position, and full description of executive and/or ministerial body.
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Duties of position
Promotion or New Position with Greater Responsibility:
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Title, Organization
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YOU MUST PROVIDE complete, updated contact information if alumnus
has moved to new company.
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Simply moving jobs is not a success story. Alumnus must have attained
position of greater responsibility in new company/organization.
Association Activity or Expansion:
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Name of association, what association does.
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Has alumnus taken a leadership position within the association? Must be
named, along with date of appointment or election.
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Has alumnus helped organize meetings, conferences, initiatives in
association? Full details must be given – names and dates of above, and their
results.
Conferences and Publications:
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Publications should include date, name of article, description of article, and
the magazine, journal, or newspaper it appeared in. When possible, e-copies
of articles should be forwarded to Washington. Hard copies can also be sent to
Washington.
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Conference participation, conference presentations, and conference organizers
are all acceptable. Full details: When, name of the conference, who attended,

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Expiration Date: xx-xx-xxxx

and brief description of conference activities and goals are required. If there is
a conference website, it should also be forwarded to Washington.
Scientific Agreements and Joint Work:
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Names and organizations of the U.S. and Eurasian parties to the agreement;
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Date of agreement, and what the agreement covers.
Business Relationships Between Alumni:
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Full names, program participation, and nature of relationship;
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Trade volumes, if applicable.

Public Burden Statement
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a
person be subject to a penalty for failure to comply with an information collection subject to the
requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently
valid OMB Control Number. The approved OMB Control Number for this information collection is
0625-0225. Without this approval, we could not conduct this information collection. Public reporting
for this information collection is estimated to be approximately 30 minutes per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the information collection. All responses to this information
collection are voluntary. Send comments regarding this burden estimate or any other aspect of this
information collection, including suggestions for reducing this burden to the International Trade
Administration Paperwork Reduction Act Program: [email protected] or to Katelynn Byers, ITA PRA
Process Administrator: [email protected].