ARSLS_Alaska_Site_Visit_Request_Application_Rev_1.pdf

Fully completed forms must be submitted to and received by Joe Cloft, NSF Contracting Officer no later than 3:00 PM local time (Virginia), March 26, 2019. Forms must be submitted via email to joscloft@nsf.gov.

National Science Foundation (NSF)

Arctic Research Support and Logistics Services (ARSLS)

Solicitation 49100419R1001

Alaska Site Visit Application Form

Proposed Attendee

Last Name:

First Name:

Middle Initial:

Phone:

Email:

Citizenship:

Birth Date:

Passport Country of Issuance:

Passport No.:

Passport Expiration Date:

Proposed Attendee’s Employer/Business Concern

Business Concern Name:

Business Concern Street Address:

Business Concern City:

Business Concern State:

Business Concern Zip:

Business Concern CAGE Code (must be currently active):

Days/Sites Applying to Visit

☐ Fairbanks, AK

☐ Toolik Field Station, AK

☐ Utqiagvik, AK

☐ Day Four, Contingency Day

☐ Day Five, Contingency Day

I, __________________________, hereby request to visit the above sites solely for understanding the requirements and submitting an Offer in response to NSF Solicitation 49100419R1001. I am the only team member submitting a site visit application for this Solicitation. Team members are defined as teaming partners, subcontractors, parent companies, affiliated companies and other employees of the business concern that is my employer. I understand and accept that I’m solely responsible for all costs of this site visit, except for the shuttle bus between Prudhoe Bay and Toolik Field Station.

Name of Attendee

______________________________________ Date: __________________

Signature of Attendee