General Biographic Data

GENERAL BIOGRAPHIC DATA
RFR Requestor is
NFNMS Originator is
Request Number is XXXXXX-00
Host Phone:
Last Edited:
Name:

Visitor Number:

Gender:

Is Visitor Currently in US?

Greencard:
Expiration Date:

Resident Alien Number:
9 Digit Social Security Number:

Citizen of:

Birth Date: Country of Birth:
City of Birth:

Affiliation or Company Info:
Institution or Company Name:

Phone:
FAX:
E-Mail Address:
Title or Position:

Street(1):
Street(2): City:
State: Zip:
Country of Employer:
Visa Information

Passport Information

Visa Number:
Type:
Expr Date:

Passport Number:
Country of Issue:
Expr Date:
NAC Information

Requested Date:

Check Completed Date: Expiration Date:
Miscellaneous Data

Interpreter Needed?
Business Type conducted by Employer:
Educational Background:

Field Of Research:
Are There Family Members who will accompany or join the applicant later? No
Remarks:

VISIT REQUEST/ASSIGNMENT LONG FORMAT
Visit Request Information
RFR Requestor is
NFNMS Originator
Request Number is AGS2006XXXXXX-00
Last Edited:
First Entered:
Center to be Visited:
Type of Request:

Area Type at the Center/Facility:

Will Sensitive Subjects be discussed?
Host's Name:
Host is Citizen of:

Host Phone:
Host have a security clearance?

Desired Start Date:

Desired End Date:

Purpose of Visit:
Cost to NASA:

Subject to be discussed:

Grant Number:
Grant Expiration Date:
Contract Number:
Contract Expiration Date:
International Agreement Code:
Required if HQ Approval is needed:
HQ Coordination Office:
HQ Coordination Office Contact:
HQ Coordination Office Phone:
Is the assignment for intermittent

Number of Days On-Site:

access periods?
Will there be interactions with
Individuals with Security Clearances?

List interactions with Individuals with
Security Clearances?

List Buildings and Rooms to be
accessed:
NASA Escort's Name:
NASA Escort's Phone Number:
Will visit/assignment include transfer
of Technology:
Mandatory if there is to be technology
transferred, describe:

Export License Required:
Date Export License Requested:
Date Export License Granted:
License Number(6 Digits):

Will Visitor/Assignee be granted
computer access?
If granted computer access, is the
access on-site or off-site?

Remarks:

General Remarks on Visit/Assignment:
Approval Conditions
Center IVC Approval: