BASE Elizabeth City Visitor Request Form_Blank.xlsx

XLSX spreadsheet 106 KB Posted

Attached to
Air Station Elizabeth City RCB Bathroom Remodel
Solicitation number
70Z08126QELIZ0003
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About this file

This is a blank visitor request form template for Base Elizabeth City, a U.S. Coast Guard installation in Elizabeth City, North Carolina. The form collects standard visitor information including name, date of birth, driver's license details, citizenship status, organization, purpose of visit, arrival and departure times, and sponsor information. All visitor requests must be submitted no later than three working days prior to the scheduled visit, with foreign visitors requiring submission at least thirty days in advance. Completed forms should be sent to d05-smb-baseecityvisitors@uscg.mil with the sponsor's contact information included.

The form references Base Elizabeth City Instruction 5512.1B for additional requirements and provides contact information for multiple tenant command security officers across various Air Station Elizabeth City departments, including the Aviation Technical Training Center, Aviation Logistics Center, Air Station Elizabeth City, Boat Station Elizabeth City, and USCG Aviation Projects Acquisition Center. The form notes that visitor requests are monitored daily and applicants will be contacted if they do not meet base entry criteria as defined in the referenced instruction or DCMS denial criteria. Instructions emphasize that the completed form contains personally identifiable information and should be saved securely before submission.

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Sheet1

Base Elizabeth City Visitor Request
For questions, contact your Command Security Officer or Base Coast Guard Police Dept. at (252) 335-6588.

***All requests shall be submitted no later than 3 working days prior to visit.*** Reference BASEECITYINST 5512.1B for additional information and requirements.

LAST NAME FIRST NAME MIDDLE INITIAL SUFFIX DATE OF BIRTH DL STATE DL# CITIZENSHIP (US/FOREIGN)

VISITOR ORGANIZATION:
PURPOSE OF VISIT:
PLACE OF VISIT:
ARRIVAL:
DEPARTURE:
SPONSOR'S NAME:Steven J. Carr (Josh)
SPONSOR'S COMMAND/AFFILIATION:Base FED
SPONSOR'S CONTACT INFORMATIONMS Teams: 206-836-4077
COMMENTS BELOW:
***FOREIGN VISITORS MUST BE SUBMITTED NO LESS THAN THIRTY DAYS PRIOR TO AN OFFICIAL VISIT***
For more information and/or guidance, contact your Tenant Command Security Officer
Base Elizabeth City and Tenant Command CSO's:
Base Elizabeth City:MEC Kealiinohomoku, Brandonn(252)335-6855
Aviation Technical Training Center (ATTC):ASTC Linehan, Michael(252)335-6917
Aviation Logistics Center (ALC):Mr. Smith, Stephen(252)384-7173
Air Station Elizabeth City:OSC Brancaleone, Paul(252)335-6761
Boat Station Elizabeth City:BM1 Jordan, William(252)335-6086
USCG Aviation Projects Acquisition Center (APAC):LT Cortez, Miguel(252)355-6279
***ALL VISITOR REQUESTS SHALL BE SENT TO THE FOLLOWING EMAIL:***
d05-smb-baseecityvisitors@uscg.mil
Instructions: Left click on the email address and an email will auto-populate. Once all fields are filled out in this visitor request, save to a safe place as this contains PII and attach this form to the email. Once you send off a visitor request you do not need to follow up, all visitor requests are monitored on a daily basis. If a member does not meet Base entry criteria as defined in BASEECITYINST 5512.1B and DCMS denial criteria, you will be contacted and the visitor request will be denied pending a follow up request. If you have any further questions please feel free to contact the CGPD.

mailto:d05-smb-baseecityvisitors@uscg.mil image1.emf image2.emf image3.emf image4.emf image5.emf

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