ACS_050515_eform.pdf

AACCSS MMiilliittaarryy AAddddiittiioonnaall CCoonnttaacctt SShheeeett ((AACCSS))

Associate Type (relationship to you): Gender:

Citizenship Status:

If associate is not currently naturalized, do they intend to become naturalized?

Past Citizenship(s) (if applicable):

Primary Phone:

Secondary Phone(s):

Work Phone:

E-Mail:

Occupation:

*If retired, list from what/where they are retired.

Employer: Employer Address:

Frequency of Current Contact:

Daily Weekly Monthly Quarterly Yearly Other (explain):

Frequency of Future Contact:

Daily Weekly Monthly Quarterly Yearly Other (explain):

Means of Current Contact In-Person E-Mail Phone

(check all that apply): Social Media Other (explain):

Means of Future Contact In-Person E-Mail Phone

(check all that apply): Social Media Other (explain):

When First Contacted (MM/YY):

When Last Contacted (MM/YY):

Describe the circumstances under which you first met:

Has this associate ever been affiliated with a foreign government or military?

Does the associate maintain contact with individuals from his/her birth country?

Is this associate aware of your US government/military/intelligence affiliation?

If you answer yes to any of the following questions, please provide a detailed answer in the space below.

Your Last Name: SSN(Last 4): Date (MM/DD/YY): Initials: