Non-U.S. Citizen Visitor Form

The following form must be completed for all non-U.S. citizen visitors to Energy Group at General Atomics per
U.S. Department of Energy Foreign Visits and Assignments Order 142.3 chg. 1. Approval must be obtained from DOE prior to the visit.

U.S. citizens do not need to complete the form.

Thank you for your cooperation in meeting this obligation.

Our secure server encrypts all of your personal bio-data information,
including passport/visa information before securely transmitting the data over the internet.

Please do not include non-english characters and special characters in your input.
Family name *
Given name*
Middle name
Employer/School*

If employer is not listed above,
please provide the employer name here
Employer Address*
Max - 250 characters
Email address *
Work phone number *
Job title or position *
If Other,
please provide the job title or position here
Detailed Purpose of Visit *
Max - 500 characters
Purpose Code of Visit *
Off-Site Meeting *
Yes
No
Date Visit Will Start (Date-Month-Year) *
- -
Date Visit Will End (Date-Month-Year) *
- -
GA Host*
GA Host Email Address*
Date of Birth * (Date-Month-Year)
- -
Gender*
Male
Female
City of Birth*
Country of Birth*
Citizenship *
Passport issued by which country? *
Passport number *
Passport expiration date (Date-Month-Year) *
- -
OR Visa Type*
Visa number*