Attachement 3 - FOUO (PII) BAL (Initial Request).docx

DEPARTMENT OF THE AIR FORCE

17TH TRAINING WING (AETC)

GOODFELLOW AIR FORCE BASE TEXAS

FOR OFFICIAL USE ONLY

xx Apr 2020

MEMORANDUM FOR 17 SFS/S5

FROM: 17 XXX/XXX (Your office symbol)

Subject: (U) Request Unescorted Base Access Pass

1. I am sponsoring the following Non-ID card holding guest requiring Unescorted access to the base for (state official purpose, i.e. briefing animal safety, construction work, etc..).

2. The following contractor or guest will need periodic access to deliver lumber to the building. (Just an example…state your particular needs) Name DOB State/DL or ID# Last 4 SSN Date(s) of Entry Days/Hours Public, John Q. 20 Apr 1933 TX 12345678 0000 10 May – 15 Jun 2019 Mon – Thurs/0700-1500

3. I will ensure Mr. Public is briefed that only properly licensed visitors, appropriately covered by vehicle insurance, will operate a vehicle on Goodfellow AFB. Authorized vehicle operators will have in their possession a valid driver’s license, current vehicle registration and a valid insurance certificate at all times when operating a vehicle on the installation.

4. Upon completion or termination of this visitor request, I will ensure his pass is returned to the Visitor Control Center.

5. If you have any questions, please contact me at (325) 654-1234. (Your contact number)

The information herein is For Official Use Only (FOUO) which must be protected under the Freedom of Information Act of 1966 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties

FOR OFFICIAL USE ONLY

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