Foreign National Access Program (FNAP) Registration Form.

Home Registration Form Visa Information Directions PPPL Homepage

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 142.3B 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.

* Details of the subject matter you will be involved in for your visit/assignment MUST be clearly indicated below.

* DENOTES REQUIRED INFORMATION
 

* ACCESS REQUIREMENTS

PHYSICAL ACCESS CYBER-ACCESS ONLY

* Upload Resume/CV ( In PDF format  file.pdf)

CV/RESUME Requirements
    o Required for all Non-U.S. Citizens.
    o Must include all employment activities since the age of 18.
    o There should be no lapses in time over the last 10 years.
    o Must include all Science & Technology specialties.
    o Must include the current and the accurate names of all the academic institutions attended.
CV content will be verified by PPPL Site Protection Administration.

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:	FemaleMale	Is visitor currently in U.S?:	YesNo
* Lawful Permanent Resident (LPR):	YesNo	* 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

No Yes

 
 

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:

*Alternate Host's First Name:

*Alternate Host's Last Name:

* Does your involvement/collaboration with PPPL involve any research or discussion about:

Accelerator Science or Technology
Battery Science or Technology
Bioscience & Biotechnology
High Performance Computing
Machine Learning/Artificial Intelligence Science or Technology
Superconducting Magnets
Quantum Information Science or Technology
Other

   

 

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

    

* Enter the specific DOE program or project that you will be participating in. If you are not participating in a DOE specific
program or project, please indicate the defining need for your access request (interview, employment, etc).

    

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

 
IMPORTANT INFORMATION
You are required to resubmit this form if any of the following change while you are accessing PPPL site and/or systems.
 
Change in name (life event, name change, additional name, etc)
Change in Citizenship Country(s)
Change in Immigration Status

You are required to disclose to your PPPL sponsor/host any civil or criminal charges against you. You may provide in the
justification section above or in a separate email to your PPPL sponsor/host. The failure to provide appropriate documentation
for this request, or providing fraudulent documentation will result in the suspension of access approval, removal from  the site,
and possible cancellation of future access. By clicking "Submit Registration Form" you are agreeing to comply with PPPL and
DOE regulations for Non-US Citizen access to the PPPL site and systems.
 
If you need further assistance in submitting this form, contact Giselle McKenzie @ 609-243-3208 or gmckenzi@pppl.gov