EAL_Form_-_Functions.pdf

ALPENA COMBAT READINESS TRAINING CENTER

MICHIGAN AIR NATIONAL GUARD

SECURITY FORCES

OFFICIAL FUNCTIONS AND GUEST LISTS

WHEN FILLED IN THIS FORM BECOMES FOUO AND CONTAINS SENSITIVE LAW ENFORCEMENT

AND PRIVACY ACT INFORMATION Page 1

Authority: 10 U.S.C. 8013 and Privacy Act of 1947

Principle Purpose: To establish an entry control access list for personnel needing unescorted access to the installation for sponsored functions

Disclosure: Information requested is voluntary, but failure to provide any of the requested information will result in access to the installation being denied.

Instructions: This form will be completed by the primary sponsor of the event requesting access for personnel needing unescorted privileges to the installation for the purpose of attending a social function not associated with training or military sponsored. Once this form is completed and certified by security forces personnel it will be posted at the installation main gate and a copy issued to the installation sponsor and maintained at the security forces administration building. This form can either be faxed (989-354-6327) or submitted to the Security Forces Pass and ID section, (Due to personal information, we cannot accept email versions, unless encrypted for the protection of the personal information) NLT 10 days prior to the function to allow for appropriate background and administrative actions to occur. All personnel (16) years of age need to have in their possession either a valid driver’s license or valid state or federal identification card. Failure to do so can prevent or delay access. NOTE: If the form is not completely filled out correctly it will be returned. It will not be considered valid until certified by appropriate security forces personnel.

Any questions can be sent to the Security Forces Pass and Identification Section at (989) 354-6370 or (989) 354-6398 or email micrtc.sfpassid@ang.af.mil

SECTION 1:

REQUESTOR INFORMATION

Type of Event:

Location of the event: Date of the Event:

Event Hours: Start Time: End Time:

Military Sponsorship

Sponsor Organization: POC (full name): Tele Number:

Printed Name of Submitter:

Signature:

Date :

mailto:micrtc.sfpassid@ang.af.mil

WHEN FILLED IN THIS FORM BECOMES FOUO AND CONTAINS SENSITIVE LAW ENFORCEMENT

AND PRIVACY ACT INFORMATION Page 2

SECTION 2:

PERSONNEL ROSTER (PLEASE TYPE)

First name listed needs to be the primary point of contact for emergencies or issues concerning the event. Please note: Names cannot be added once the final list is submitted and validated due to the issue of accomplishing the background checks.

COMPLETE NAME

(LAST, First, Middle)

COMPLETE ADDRESS

(Street, Apt #, City, State, Zip)

Last 4 of

SSN

DOB

(MMDDYYYY)

DRIVER’s LICENSE #

(State and Number)

SF USE

ONLY

BACKGROUND CHECKS

TYPE Cleared Denied

Section 3

Office Use Only

Date Received: Received From:

Security Forces Representative: Signature: