Attach 3 NIST 1260 Form Template.pdf

NIST-1260

(REV. 10-2015)

NIST PR 1400.01

U.S. DEPARTMENT OF COMMERCE

NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY

REPORT OF FOREIGN VISITOR(S), GUEST(S), CONFERENCE ATTENDEE(S)

REQUIRED FOR ALL FOREIGN VISITORS/GUESTS -- 48 HOURS IN ADVANCE FOR VISITORS AND CONFERENCE ATTENDEES

(SEND ORIGINAL TO IAAO) --30 DAYS IN ADVANCE FOR GUESTS (SEND ORIGINAL TO OSY, COPY TO IAAO)*

Administration Forms

CITIZENSHIP COUNTRIES OF DUAL CITIZENSHIP (If applicable)

NIST HOST(S) (Name, extension, e-mail) ORGANIZATIONAL CODE NUMBER

REASON FOR VISIT OR TITLE OF LECTURE(S)

ROOMS/BUILDINGS TO BE UTILIZED

REPORT PREPARED BY TELEPHONE EXTENSION DATE

FOLLOWING REQUIRED FOR LECTURERS ONLY (including signatures)

LECTURERS ONLY - GIVE BRIEF BIOGRAPHY

DIVISION CHIEF (NAME AND SIGNATURE) OU APPROVAL (NAME AND SIGNATURE)

RESPONSIBLE TECHNICAL STAFF MEMBER TELEPHONE EXTENSION ORGANIZATIONAL CODE NUMBER DATE

LECTURE FEE TRAVEL PER DIEM

APPROVED - INTERNATIONAL AND ACADEMIC AFFAIRS OFFICE (NAME AND SIGNATURE) DATE

FULL NAME

First Middle

DATE OF BIRTH

Last Month Day Year

PLACE OF BIRTH PASSPORT

City Country Issuing Country

TITLE/POSITION

GENDER Male Female

EMPLOYER/SPONSOR TELEPHONE

ADDRESS

DATE(S) OF VISIT

COUNTRY OF RESIDENCE

Number

GUEST (more than 3 days)VISITOR (3 days or less)

*BOULDER DISTRIBUTION: Original to Security; Copy to Group and IAAO (Mail Stop 1090)

CONFERENCE ATTENDEE (5 days or less)

U. S. PERMANENT RESIDENT YES NO

EMAIL