Request for visit by foreign national




Yüklə 32.68 Kb.
tarix16.04.2016
ölçüsü32.68 Kb.


REQUEST FOR VISIT BY FOREIGN NATIONAL

PART A

1. Visitor Last Name (Family)

2. First Name (Given)

3. Middle Name (if any)

     


     

     

4. Dates of Visit (MM-DD-YYYY)

5. This request is for:

6. Is student currently in US?

mm-dd-yyyy To mm-dd-yyyy

 Official Visit  Unofficial Visit  Student

 Yes  No

7. Reason for visit or title of course



8. Gender

9. Place of Birth (City, Country)

10. Date of Birth (MM-DD-YYYY)

 M  F


     

mm-dd-yyyy

11. Country(ies) of Citizenship

12. Passport Number

13. Expiration Date (MM-DD-YYYY)

     


     

mm-dd-yyyy

Immigration Status


14. Type of Visa Card Number (if Permanent Resident)

15. Expiration Date (MM-DD-YYYY)

           

mm-dd-yyyy

16. Name of Current Employer

     

17. Address of 

Street

City

     

     

State/Province

Country

Zip/Post Code

     

     

     

18. Title, Position, or Description of visitor’s duties

Enter Your Job Title (i.e. Pilot, Engineer, Doctor, etc.)

19. Name of FAA Point of Contact [sponsor] (POC)

20. FAA POC [sponsor] Organization

Eric Simson

AAM-400

21. FAA POC [sponsor] Telephone Number 405-954-4837

22. Facility(ies) to be visited (include building name/number, room number, and address of facility(ies))

CAMI, Room B33

6600 S. MacArthur Blvd



Oklahoma City, OK


23. AIA Approval  Yes  No

24. Security Approval  Yes  No

FAA Form 1600-78 (3-03)

PART B

25. Does the visit involve the exchange of any of the following categories of unclassified information?

a. Sensitive Security Information?  Yes  No

b. Product or system demonstration?  Yes  No

c. Viewing, disclosure, or release of object code?  Yes  No

d. Discussion of changes to software?  Yes  No

e Viewing, disclosure, or release of source code?  Yes  No

f. Examination of technical documentation?  Yes  No

g. Maintenance training?  Yes  No

h. Other (describe/explain below)?  Yes  No

If block 25b, c, d, e, f, g, or h, is marked “Yes”, describe the information and/or technology involved.

     


26. AGC-500 review (to be completed only if block 25c, d, e, f, g, h, or I is marked “Yes” )

Consistent w/Export Restrictions?  Yes  No

Appear on Denied Persons list?  Yes  No

FAA Form 1600-78 (3-03)



Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©azrefs.org 2016
rəhbərliyinə müraciət

    Ana səhifə