PWS_Attachment 5 USAFA Form 13.pdf

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michelle.winter 11.0.1.20130826.2.901444

APPLICATION FOR UNITED STATES AIR FORCE ACADEMY ACCESS CREDENTIAL

SECTION 1. APPLICANT STATUS

Work Purposes

DAYS OF WEEK: (M,T,W,TH,F,SAT,SUN)

DURATION REQUESTED: See Instructions HOURS: (Ex: 0300-2200) Volunteer

SECTION 2. APPLICANT INFORMATION

2.1. APPLICANT NAME/CONTACT NUMBER:

2.2. SPONSOR NAME/CONTACT NUMBER:

2.3. SPONSOR UNIT/SPONSORING AGENCY:

YES

NO

SECTION 3. ACCESS JUSTIFICATION

3.1.

(Describe in detail why the applicant requires long term access to the Air Force Academy. If FPCON C, Escort, or 24 Hour access privileges are required then proper justification will be annotated in this section.):

3.2. FPCON C ACCESS:

3.3. ESCORT PRIVILEGES:

YES

NO

AUTHORIZED SIGNER SIGNATURE

YES

NO

AUTHORIZED SIGNER SIGNATURE

SECTION 4. CADET AREA/AIRFIELD ACCESS JUSTIFICATION

4.1.

(IAW AFMAN 31-113_USAFASUP, Installation Perimeter Access Control, access to the cadet area is for mission- essential personnel only; must directly support the USAFA mission. Access for convenience is NOT authorized.)

4.2. CADET FACILITIES AUTHORIZED SIGNER

4.3. AIRFIELD ACCESS

(Training required BEFORE access granted):

YES

NO

CADET FACILITIES REQUIRED:

YES

NO

SECTION 5. SPONSOR/SPONSORING AGENCY AUTHORIZATION

As the authorized signer, I certify understanding making a false, fictitious, or fraudulent claim may result in the prosecution under Title 18, United States Code, Section 1001, or other applicable laws and regulation.

For Work Purposes: I certify the applicant is performing in an official capacity on the identified contract and requires access in the performance of their official duties.

5.1. SPONSOR SIGNATURE:

5.2. DATE:

SECTION 6. 10TH SECURITY FORCES SQUADRON PROCESSING

6.1. NCIC/CCIS CHECK COMPLETED:

6.2. ACCESS GRANTED:

6.3. BADGE EXPIRATION (10 SFS staff use Only)

CA:

YES

NO

AIRFIELD:

YES

NO

ESCORT:

YES

NO

FPCON C:

YES

NO

2.4. FOREIGN NATIONAL: If checked yes, the applicant must provide their work Visa.

USAFA FORM 13, 20190812 Valid for ONLY 10 business days

10th Security Forces reserves the right to deny the above privileges if proper justification is not provided.

Security Forces Authorized USAFA FORM 13, 2018XXXX (Reverse) Valid for ONLY 10 business days

INSTRUCTIONS FOR COMPLETING THE USAFA FORM 13

Section 1. Applicant Status: Sponsors must select either work purposes, or volunteer. It is imperative the appropriate applicant status is marked since each status requires different procedures as identified in this supplement.

DAYS OF WEEK: Annotate the days of the week the applicant will require access on to the installation. Sponsoring authority must annotate the appropriate days of the week for the applicant to prevent the production of multiple badges for a single applicant as there is a cost associated to each card.

HOURS: Annotate the hours.

DURATION REQUESTED: Annotate how long the credentials are needed for.

Short-Term visitor (less than 90 days) will be issued a paper pass; DBIDS card will be issued if cadet access is required for longer than 30 days. Cadet Access less than 30 days will require a USAFA Form 120T processed by sponsoring unit.

Long-Term visitors will be issued a DBIDS card up to but not to exceed 1092 days. Exception: The Aero Club, Archery Club, Civil Air Patrol, Equestrian Center, Fisherman Access, and Learn to Skate are only authorized up to but not to exceed 363 days. Requests for work purposes may be up to 363 days not exceed the duration of the contract. Exception: The Air Force Academy Athletic Corporation (AFAAC) employees (not contractors) are authorized DBIDS cards for up to but not to exceed 1092 days. Volunteers will be issued a DBIDS card up to but not to exceed 1 year.

Section 2. Applicant Information:

APPLICANT NAME/CONTACT NUMBER: As listed on ID.

SPONSOR NAME/CONTACT NUMBER: Must print legibly or type in order for 10 SFS to be able to contact the sponsor if needed. 10 CONS personnel are authorized to use their stamps.

SPONSOR UNIT/SPONSORING AGENCY: Self-explanatory.

Section 3. Access Justification: Describe in detail why the applicant requires routine, 24 hr, FPCON, and escort access to the Air Force Academy.

*******************Annotate Prime Contractors Name and Contact Number.

FPCON C ACCESS: This section is for work purposes only. Provide detailed justification.

ESCORT PRIVILEGES: This section is for work purposes only. Authorized signers will annotate whether the applicant requires escort authority. Applicant must meet the escort requirements as defined by this publication/supplement. 10 SFS PRC staff will not annotate this access on DBIDS cards unless the initials (signature) of the authorized signers are present. Work purposes must be signed by Authorized Signer. Volunteers requiring escort must annotate justification in 3.1. and be signed by the sponsoring organizations Director of Staff (DS) or Mission Element (ME) Commander, HQ USAFA volunteers will be signed by USAFA/CM. USAFA/CW spouses will be approved by DS level or higher with a final approval by 10 MSG/CC. AOG will be approved by USAFA/CM.

Section 4. Cadet Area/Airfield Access Justification:

4.1. If access to the cadet area is required, the sponsor must describe in detail why the applicant's unescorted access is required and how access directly supports the USAFA mission. Access for convenience is not authorized. Additionally, the sponsor must indicate if unescorted access to any facilities is required by checking the applicable box at the bottom of this block. The sponsor must annotate specific facilities that the applicant requires access.

4.2. SIGNATURE OF AN AUTHORIZED SIGNER: The PRC staff must have a DD Form 577 for all appointed authorized signers for contractors as identified in Paragraph 1.5.16.2.1.2. of the supplement and for all personnel who have been designated by their Unit Commander/Director, AOC, or designated representative of their organization. Signature is only required in this block if cadet area access is required.

4.3. AIRFIELD ACCESS: If unescorted access is required to the airfield, the sponsor must check the applicable box in the block. In order to obtain unescorted access onto the airfield, an Airfield Access Memorandum must be provided before access is granted; access will not be granted without the memorandum.

Section 5. Sponsor/Sponsoring Agency Authorization:

5.1. SPONSOR SIGNATURE: For work purposes, this is the signature of an authorized signer as identified in Paragraph 1.5.16.2.1.2. of this supplement. This is the signature of a member of the Sponsoring Agency. For Security Forces Authorized, this is the signature of the member whom services are being rendered.

5.2. DATE: The date the sponsor signs the application.

Section 6. 10TH SECURITY FORCES SQUADRON PROCESSING: This section is reserved for 10 SFS PRC personnel only.

It is up to the sponsoring authority to ensure that all required access is annotated properly.