Visitor-Prenotification-Form.pdf
PDF 45 KB Posted
- Solicitation number
- HDTRA225RE0010001
- Issued by
-
Defense Threat Reduction Agency
About this file
The document is a Kirtland Air Force Base Short Term Visitor Pass Pre-Notification Form dated February 2017. The form is designed for sponsors to request and record visitor access to Kirtland Air Force Base, with specific requirements for submission and pass issuance. Key details include a mandatory 72-hour advance submission to the Visitor Control Center, requirements for a valid government-issued photo ID, and restrictions on pass duration (maximum 30 days). Visitors must be sponsored, and the sponsor assumes responsibility for the visitor's actions, with potential loss of sponsorship privileges for non-compliance. The form requires comprehensive visitor and sponsor information, including personal details, citizenship status, and specific access parameters.
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Text version
February 2017
KIRTLAND AFB
SHORT TERM VISITOR PASS
PRE-NOTIFICATION FORM
SPONSOR INFORMATION
FIRST NAME
LAST NAME
FULL SSN
ORGANIZATION
CONTACT PHONE
This form must be completed and submitted to the Gibson Visitor Control Center (VCC) or Truman VCC no earlier than 72 hours prior to visitor arrival. Upon form submittal, VCC personnel will validate sponsorship authority and verify the form is completed correctly. The visitor must report to the designated VCC with a valid government issued picture ID card (DL, State ID, etc.) to obtain a pass. This form must be submitted prior to visitor arrival or the sponsor will be required to report to the VCC to obtain a pass for the visitor.
VISITOR INFORMATION (one visitor per form)
FIRST NAME
MIDDLE NAME
LAST NAME
DATE OF BIRTH
DRIVER LICENSE STATE
US CITIZEN YES___ NO___ (If no, list country of citizenship)___________________________
PASS INFORMATION
The duration of this pass cannot exceed 30 days. If the visitor has 3 or more passes totaling 30 days or more within a 90 day period, the sponsor and visitor will be required to follow the procedures to obtain a long term pass.
DESTINATION(S)
START DATE
END DATE
ACCESS TIMES (i.e. 0730-1630)
SPONSOR ACKNOWLEDGMENT
I understand that I am responsible for the actions of all visitors I sponsor onto the installation. I understand that failure to comply with instructions could result in my loss of sponsorship privileges. If you need more information, please contact me at the above number.
DATE SPONSOR SIGNATURE
PRIVACY ACT STATEMENT: The contents of this/these document(s) shall not be disclosed, discussed, or shared with individuals unless they have a direct need-to-know in the performance of their official duties. Deliver this/these document(s) directly to the intended recipient. DO NOT drop off with a third party. ROUTINE: To request and record the issuance of a Visitor when the use of another form is not authorized. Failure to provide any of the information requested may result in non-issuance of the Visitor Pass. This information is necessary for validation of the sponsor’s identity and determination of entry eligibility of the visitor onto Kirtland Air Force Base. Failure to provide this information may result in a non-issuance determination by the issuing authority.
| FIRST NAME: |
| LAST NAME: |
| FULL SSN: |
| ORGANIZATION: |
| CONTACT PHONE: |
| FIRST NAME_2: |
| MIDDLE NAME: |
| LAST NAME_2: |
| DATE OF BIRTH: |
| DRIVER LICENSE STATE: |
| If no list country of citizenship: |
| DESTINATIONS: |
| START DATE: |
| END DATE: |
| ACCESS TIMES ie 07301630: |
| DATE: |
| Check Box1: Off |
File details come from the government source that posted it. Updated .