Apdx 1 - Site Visit Badge Request Form.docx
DOCX document 20 KB Posted
- Attached to
- KSC Electrical BPA Construction Services Federal contract opportunity
- Solicitation number
- 80KSC024R0005
About this file
This document is a site visit badge request form for Kennedy Space Center. The form requests information such as visitor name, dates of visit, social security number, date and place of birth, citizenship status, home address, phone number, position, employer details, and point of contact. It is to be used by visitors requesting access to Kennedy Space Center installations for purposes such as visits or work.
The related federal contract opportunity is a blanket purchase agreement for electrical construction services at Kennedy Space Center. Solicitation number 80KSC024R0005 was issued by NASA's Kennedy Space Center for electrical BPA construction services. The opportunity type is a solicitation and involves construction and maintenance work at KSC facilities.
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Text version
US Citizen IdMAX Identity Information
Protected table, tab through to answer questions Start Date of Visit:
End Date of Visit:
Installation(s) to be visited (include all building #’s & room #’s) and justification (or purpose) of visit:
Last Name:
First Name:
Middle Name:
Gender (M or F):
Social Security Number:
Date of Birth (Month/Day/Year):
Place of Birth:
(City, State/Province AND Country)
| If born to US citizen parents outside the US? |
(Provide location)
| Are you a Permanent Resident Alien (Greencard Holder) |
| (If Yes, Number) |
| (Expiration) |
| Are you a Naturalized Citizen? |
| If Yes, Number: |
Location:
| Date of Issue (Month/Day/Year) |
| Expiration Date (Month/Day/Year): |
Permanent Home Address (include City, State, Zip):
Cell Phone:
E-Mail:
Position Title:
Employer
Institution or Company Name:
Address (Include City, State, Zip):
Phone:
Visitor’s Affiliation KSC
Point of Contact Name:
Phone Number:
Revised 12/16/22
File details come from the government source that posted it. Updated .