Registration Form — PPPL Foreign National Access Program

CV/Resume Requirements
• Required for all Non-U.S. Citizens.
• Must include all employment activities since the age of 18.
• There should be no lapses in time over the last 10 years.
• Must include all Science & Technology specialties.
• Must include the current and accurate names of all academic institutions attended.
CV content will be verified by PPPL Site Protection Administration.

* Countries participating in the Visa Waiver Program should indicate N/A in the Visa Number, Type, and Expiration fields.

* Does your involvement/collaboration with PPPL involve any research or discussion about:

Accelerator Science or Technology Battery Science or Technology Bioscience & Biotechnology High Performance Computing Machine Learning/Artificial Intelligence Science or Technology Superconducting Magnets Quantum Information Science or Technology Other

Question	Response
* Will Computer access be granted?	Yes No
* Will you be getting a PPPL Computer Account?	Yes No
* Type of Computer Access needed	Onsite Only Offsite Both None
* List any network, hardware, and software to which access is granted:

Question

Response

* Will Computer access be granted?

Yes No

* Will you be getting a PPPL Computer Account?

Yes No

* Type of Computer Access needed

Onsite Only Offsite Both None

* List any network, hardware, and software to which access is granted:

When you click the button below, a confirmation email will be sent to the address you provided above.

IMPORTANT INFORMATION
You are required to resubmit this form if any of the following change while you are accessing the PPPL site and/or systems:

Change in name (life event, name change, additional name, etc.)
Change in Citizenship Country(s)
Change in Immigration Status

You are required to disclose to your PPPL sponsor/host any civil or criminal charges against you. Please provide these in the justification section above and in a separate email to your PPPL sponsor/host.

The failure to provide appropriate documentation for this request, or providing fraudulent documentation, will result in the suspension of access approval, removal from the site, and possible cancellation of future access. By clicking "Submit Registration Form" you are agreeing to comply with PPPL and DOE regulations for Non-US Citizen access to the PPPL site and systems.

If you need further assistance submitting this form, contact Madeline Davenport @ mdavenpo@pppl.gov or 609-243-2882 or Giselle McKenzie @ 609-243-3208 or gmckenzi@pppl.gov

* First Name (as on passport)
Middle Name (as on passport)
* Last Name (as on passport)
* Purpose of Access to PPPL	(max 70 characters)

* Gender	Female Male	Are you currently in the U.S.?	Yes No
* Lawful Permanent Resident (LPR)	Yes No	* Date of Birth (mm/dd/yyyy)
* Country of Citizenship		* City of Birth
* Country of Birth

* Institution / Company Name		* Phone Number
Street		Fax Number
City		State
Zip Code		* Country of Employer
* Your E-Mail Address
* Title of Position
* Work Place Different from Employer?

* Visa / Green Card Number		* Passport Number
* Visa Type		* Country of Issue
* Visa Expiration (mm/dd/yyyy)		* Passport Expiration Date

* Host's First Name		* Host's Last Name
* Alternate Host's First Name		* Alternate Host's Last Name