Registration Form For Non-U.S. Citizens Visiting the Princeton Plasma Physics Laboratory 2015

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For those persons visiting PPPL and who are NOT U.S. citizens, the following form is required.

PPPL is obligated to comply with the U.S. Department of Energy Order 142.3A for persons visiting the site who are not citizens of the United States of America.  All such persons must have approval prior to visiting PPPL.  If approval is not received, the non-U.S. citizen could be denied access to the PPPL site.  The form below is only for persons who are NOT U.S. citizens.  If you are a U.S. Citizen, you do NOT need to complete this form.


 * DENOTES REQUIRED INFORMATION
 
* ACCESS REQUIREMENTS  

NAME OF VISITOR/ASSIGNEE

* First name as it appears on your passport:         

   Middle name as it appears on your passport:

* Last name as it appears on your passport:         

PLEASE ENTER PURPOSE OF YOUR VISIT TO PPPL:

*   (Max 70 Characters)   

BIOGRAPHICAL INFORMATION

* Gender:        Is visitor currently in U.S?:  
* Permanent Resident Alien:        * Date of Birth(mm/dd/yyyy):    
* Country of Citizenship:          * City of Birth:    
* Country of Birth:           

EMPLOYER INFORMATION

Affiliation or Company Info:
* Institution or Company Name:     Phone Number:  
Street:   Fax Number:  
    * E-Mail Address:    
City:   State:  
Zip Code:   * Country of Employer:    
Title of Position:  

* IS YOUR PLACE OF WORK DIFFERENT THAN THAT OF YOUR EMPLOYER  
 
 

VISA/PASSPORT INFORMATION

* NOTE - Countries participating in the Visa Waiver Program should indicate N/A in the Visa Number, Type and Expiration fields.

* Visa or Green Card Number:     * Passport Number:    
* Visa Type:     * Country of Issue:    
* Exp. Date(mm/dd/yyyy):     * Exp. Date(mm/dd/yyyy):    

PPPL HOST INFORMATION

* Host's First Name:  
   
* Host's Last Name:  
 

VISIT INFORMATION
* Desired Start Date(mm/dd/yyyy):  
   
* Desired End Date (mm/dd/yyyy):  
   

Enter Justification of Visit/Assignment below, including specific activities or involvement, and any other remarks:

  

 
 
When you click the button below a confirmation email
will be sent to the E-Mail address you provided above.
 
 
 
 
 
  

If you need further assistance in submitting this form, contact Dina Christie @ 609-243-2898 or dchristi@pppl.gov

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