SMR4 Attachment J-16 -Request For Visit Foreign National FAA Form 1600-78 pending.pdf

REQUEST FOR VISIT BY FOREIGN NATIONAL

PART A

1 Visitor Last Name (Family) 2 First Name (Given) 3 Middle Name (if any)

4 Dates of Visit (MM-DD-YYYY)

To

5 This request is for

• Official Visit • Unofficial Visit • Student

6 Is visitor/student currently in US9

• Yes D No

7 Reason for visit or title of course

1 Gender

• M • F

9 Place of Birth (City, Country) 10 Date of Birth (MM-DD-YYYY)

11 Country(ies) of Citizenship 12 Passport Number 13 Expiration Date (MM-DD-YYYY)

Immigration Status 14 Type of Visa 15 Expiration Date

16 Name of Current Employer

17 Address of Current Employer

Street City

State/Province Country Zip/Post Code

18 Title, Position, or Description of visitor's duties

19 Name of FAA Point of Contact [sponsor] (POC) 20 FAA POC [sponsor] Organization

21 FAA POC [sponsor] Telephone Number

22 Facility(ies) to be visited (include building name/number, room number, and address of facility(ies))

23 AIA Approval • Yes • No

24 Security Approval • Yes • No

FAA Form 1600-78 (3 03)

PARTB

25 Does the visit involve the exchange of any of the following categories of unclassified information'?

a Sensitive Security Information'? • Yes • No b Product or system demonstration'? • Yes • No c Viewing, disclosure, or release of object code9 \Z\ Yes \Z\ No d Discussion of changes to software9 • Yes • No e Viewing, disclosure, or release of source code9 • Yes • No f Examination of technical documentation9 • Yes • No g Maintenance training9 • Yes • No h Other (describe/explain below)9 • Yes • No

If block 25b, c, d, e, f, g, or h, is marked "Yes", describe the information and/or technology involved.

26 AGC-500 review (to be completed only if block 25c, d, e, f, g, h, or I is marked 'Yes")

Consistent w/Export Restrictions9 Q Yes • No Appear on Denied Persons list9 • Yes • No

FAA Form 1600-78 (3-03)