Foreign Guest Researchers

General Information for Foreign Guest Researchers
Personal Information
Last Name	First Name		Middle Name		Suffix (Jr. III etc.)
      FORMTEXT      	      FORMTEXT      		     		     
Home Address
Street	     		City		     
County/Province	     		State		     
Country	     		Zip/Postal Code		     
Place of Birth
City	     		State		  
County/Province	     		Country		     
Citizenship	     		Gender		     
Are you a Permanent Resident? (Y/N)			     
Date of Birth (MM/DD/YYYY)			     
Passport Number			     
Mother’s Maiden Name			     
Emeritus Status (Y/N)			     
Employed by another federal agency(Y/N)			     
Other Names Used And Dates When Used
Guide: Give other names you used and the period of time you used them (for example: your maiden name, name[s] by a former marriage, former name[s], alias[es], or nickname[s]). If the other name is your maiden name, put "nee" in front of it. Only required for security forms.
Last Name		First Name		Middle Name
     		     		     
Dates Used		From		To
		     		     
Last Name		First Name		Middle Name
     		     		     
Dates Used		From		To
		     		     
Last Name		First Name		Middle Name
     		     		     
Dates Used		From		To
		     		     
Contact Information for NIST Associate (prior to arrival)
Guide: An e-mail address is required for security processing in e-QIP (Electronic Questionnaires for Investigations Processing). An e-mail address or telefax must be provided (e-mail address preferred) in the contact information section for Foreign Guest Researcher.
E-mail Address:       Telefax Number:      

Employer/Home Organization
Guide: The NIST associate's employer or home organization can be one of the following: (1) the associate's employer, (2) the educational institution (university or college) that the associate attends when not working at NIST, (3) a business owned by the associate, or (4) "SELF" if associate is self-employed or a retiree, and not associated with any incorporated business. Street address is mandatory for all guest researchers. City, state, and zip code are required for NIST Associates only if the country is U.S. The second line of street address cannot be used for foreign guest researchers.
Organization Name		     
Street Address		     
Address Line 2		     
Address Line 3		     
City		     		State		  
County/Province		     		Country	     	Zip	     
Sponsor Information
Guide: The sponsor can be one of the following: (1) employer/home organization, (2) an organization that has signed a CRADA or IPA agreement with NIST, (3) "SELF" for associates who are retirees or self-employed and not associated with any incorporated business, or (4) other organization that sponsors the NIST Associate. Street address is mandatory for all guest researchers. City, state, and zip code are required for NIST Associates only if the country is U.S. The second line of street address cannot be used for foreign guest researchers.
Sponsor Name		     
Street Address		     
Address Line 2		     
Address Line 3		     
City		     		State		  
County/Province		     		Country	     	Zip	     
Emergency Personal Contact
Guide: A phone number must be provided for the contact.
Last Name			First Name
     			     
Phone Number	     

Information for Foreign Guest Researchers

Employer/Home Organization Contact

Last Name

First Name

Phone Number

     

     

     

Education Information

Guide: The street address of the educational institution is not mandatory. City and state are required for NIST Associates only if the country is U.S. Tip: The correct format for entering dates attended is "MM/01/YYYY." An exact day of the month is not required.

Educational Institution – I

School Name

     

Street Address

     

Address Line 2

     

Address Line 3

     

City

     

State

  

County/Province

     

Country

     

Zip

     

Subjects Studied

     

Dates Attended

From

To

     

     

Highest Degree(s) Awarded

     

Information About Foreign Guest Researchers

Social Security Number And Financial Support Information

Social Security Number

     

Financial Support from Sponsor or Employer? (If yes, enter amount below)

     

Amount ($0.00)

     

Contact Information For Guest Researcher

Guide: An e-mail address or telefax must be provided (e-mail address preferred) in the contact information section.

E-Mail

     

Telefax

     

Security

Has the United States Government ever investigated your background and/or granted a security clearance?

      Yes       No

If Yes, provide Agency Security Officer name & phone number.

     

Have you worked at NIST in the past?

      Yes       No

This collection of information contains Paperwork Reduction Act (PRA) requirements approved by the Office of Management and Budget (OMB). Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the PRA unless that collection of information displays a currently valid OMB control number. Public reporting burden for this collection is estimated to be 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any aspect of this collection of information, including suggestions for reducing this burden, to the National Institute of Standards and Technology, Attn: XXAdd-Individual-Point-of-Contact_InformationXX.

OMB Control No. 0693-XXXX

Expiration Date: XX-XX-XXXX

NIST Associate General Questionnaire 5