16-R-0009_SOW_Atch_4 _Foreign_National_Access_Policy.pdf

1147356664C Text Box SOW Attachment 4

REQUEST FOR FOREIGN NATIONAL ACCESS TO WHITEMAN AIR FORCE BASE

Sponsor Name: _______________________________________________________

Sponsor Military/Government Employee Status: _____________________________

Security Clearance Status:

PRP Status:

Sponsor Unit/Address: _________________________________________________

Name of Foreign National: ______________________________________________ (use a separate request for each individual)

Country of Citizenship: ________________________________________________

Country of Residence: _________________________________________________

Holds Passports From: _________________________________________________ (list all countries)

Government ID #1: __________________Government ID #2: _________________

Dates of Requested Access to Whiteman Air Force Base: ______________________

Reasons for Requesting Access: ___________________________________________

Sponsor Signature: ________________________________ Date: _______________ By signing above, I acknowledge I am responsible for all activities and actions of the above foreign national I am sponsoring onto Whiteman AFB, to include his/her behavior and the areas he/she travels. I agree to provide direct guidance and supervision over him/her at all times and understand I will be held accountable for his/her actions.

Received by 509 SFS: ____________________________________ (date/time/initials)

OSI Review:

OSI Special Agent Signature: _____________________________________________

Command Decision: Base Access

Note Any Limits/Conditions: ______________________________________________

Signature: _________________________________________ Date: ______________