Foreign Visitor Information Sheet
(Please TYPE OR PRINT)

First Name: ____________________________________
Middle Name or Initial or NMI (No Middle Initial): ____________________
Last (or Family) Name: _____________________
Gender:         Male  _____     Female:  _____
U.S. Social Security Number (if applicable):  ____________________
Are you a Permanent Resident Alien (Greencard Holder): No ___    Yes ___ 
    If Yes, Number: _____________________; Expiration Date:  _____________
Date Issued (mm/dd/yyyy): _________________
Expiration Date (mm/dd/yyyy):  ________________
Country of Citizenship: ______________________
Date of Birth:  Month_____________  Day_______  Year  ________
Country of Birth: __________________	City of Birth:  ____________________
Permanent Home Address: _______________________________________________________________

Place & Date of Entry into U.S.:
Current U.S. Address (if applicable):

NASA Installation to be visited: ________________________
NASA Point of Contact: _____________________________
Planned dates of visit (inclusive): ____________________________________

Affiliation or Employer:
Institution or Company Name:  _________________________________
Street Address:  ____________________________________________
City:  _____________________________________________________
State/Country: _____________________
Zip Code: ______________
Title or Position and Duties: __________________________________________________________
Phone Number:  	_______________________
Fax Number:      	_______________________
E-mail Address:	_______________________
	
U.S. Visa Information:
U.S. Visa Type (e.g.; B-1/B-2, H-1B, J-1, F-1, etc): _________________
Visa Expiration Date (mm/dd/yyyy): _________________
If J-1, name of U.S. Program Sponsor (attach IAP-66):  _______________

Passport Information:		
Country of Issue: _________________
Passport Number: ________________
Passport Expiration Date (mm/dd/yyyy): 	_________________