AUTHORIZATION FORM FOR DOMESTIC (U.S.) VISITORS TO THE

PRINCETON PLASMA PHYSICS LABORATORY

(Page 1 of 2)

Visitor Full Name: Date of Birth:

Citizenship: [USA]{.underline}

Place of Birth (city/region and country):

> \[*Foreign Nationals must complete Section II.C of Procedure GEN-008
> and Attachment 3 "UNCLASSIFIED FOREIGN NATIONAL VISIT/ASSIGNMENT FORM"
> in lieu of this form.*\]

Employer, Institution or Organization Represented:

Employer, Institution or Organization Country:

Title or Expertise of Visitor:

Facilities to be Visited: [PPPL]{.underline}

\[Check one\] Visit [X]{.underline} Assignment Sensitive Subjects to be
Reviewed? Yes No [X]{.underline}

> \[*If yes, contact the Site Protection Division.*\]

Is Visit a High Level Protocol Visit? Yes No [X]{.underline}

Estimated Start Date: [August 2, 2005]{.underline} Estimated Completion
Date: [August 4, 2005]{.underline}

Justification of Visit/Assignment Including Specific Activities:

[Workshop on Nonlocal, Collisionless Electron Transport in
Plasmas]{.underline}

Host Full Name: [Igor Kaganovich]{.underline} Host Citizenship:
[Russia]{.underline}

Host Clearance: Yes No [X]{.underline} Host Telephone Number:
[609-243-3277]{.underline}

Remarks:

Visitor E-Mail (at home institution): Host E-Mail:
[ikaganov@pppl.gov]{.underline}

Visitor Telephone Number (at home institution):

-   Site Access Notification Form Completed (check)

###### Note -- this is available via the web at http://www-local.pppl.gov/SiteAccess.html

> and is required to be completed before visitor arrives.

(continued on Page 2)

AUTHORIZATION FORM FOR DOMESTIC (U.S.) VISITORS TO THE

PRINCETON PLASMA PHYSICS LABORATORY

(Page 2 of 2)

Official DOE/PPPL Exchange Agreement Visit? Yes No

Visit/Assignment Supported By:

(Home Institution, other)

Amount of Financial Support:

(Visitors on full salary from U.S. institutions need only so state)

Source of Support:

(e.g., DOE contract, etc.)

Expenses to be Paid by PPPL: Travel: Yes No

Lodging: Yes No

Subsistence: Yes No

*Lodging Location/Telephone Number:*

Cost Center to be Charged: CC Manager's Signature:

Does Visitor Carry His/Her Own Medical Insurance? Yes No

Division Head/Date Host/Date

Department Head/Date Deputy Director (if required)

+-----------------------------------------------------------------------+
| Send the completed form to: D. Stevenson (Site Protection Division,   |
| MS-01)                                                                |
|                                                                       |
| Send copies to: C. Murphy (Director's Office, MS-37)                  |
|                                                                       |
| S. Meade (Travel Office, MS-11)                                       |
+-----------------------------------------------------------------------+

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**\[*To be completed once visit/assignment is completed*\]**

Was Visit/Assignment Fulfilled? Yes No

Actual Start Date: Actual Completion Date:

Revised 12/04