<table style="width:100%;">
<colgroup>
<col style="width: 16%" />
<col style="width: 4%" />
<col style="width: 7%" />
<col style="width: 12%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 19%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 4%" />
<col style="width: 22%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="13">REQUEST FOR VISIT BY FOREIGN NATIONAL</td>
</tr>
<tr class="even">
<td colspan="13"><p id="part-a" class="heading">PART A</p></td>
</tr>
<tr class="odd">
<td colspan="4">1. Visitor Last Name (Family)</td>
<td colspan="4">2. First Name (Given)</td>
<td colspan="5">3. Middle Name (if any)</td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="4">     </td>
<td colspan="5">     </td>
</tr>
<tr class="odd">
<td colspan="3">4. Dates of Visit (MM-DD-YYYY)</td>
<td colspan="7">5. This request is for:</td>
<td colspan="3">6. Is student currently in US?</td>
</tr>
<tr class="even">
<td colspan="3">mm-dd-yyyy To mm-dd-yyyy</td>
<td colspan="7"> Official Visit Unofficial Visit Student</td>
<td colspan="3"> Yes No</td>
</tr>
<tr class="odd">
<td colspan="13"><p>7. Reason for visit or title of course</p></td>
</tr>
<tr class="even">
<td>8. Gender</td>
<td colspan="10">9. Place of Birth (City, Country)</td>
<td colspan="2">10. Date of Birth (MM-DD-YYYY)</td>
</tr>
<tr class="odd">
<td> M F</td>
<td colspan="10">     </td>
<td colspan="2">mm-dd-yyyy</td>
</tr>
<tr class="even">
<td colspan="6">11. Country(ies) of Citizenship</td>
<td colspan="3">12. Passport Number</td>
<td colspan="4">13. Expiration Date (MM-DD-YYYY)</td>
</tr>
<tr class="odd">
<td colspan="6">     </td>
<td colspan="3">     </td>
<td colspan="4">mm-dd-yyyy</td>
</tr>
<tr class="even">
<td colspan="2" rowspan="2"><h1
id="immigration-status"><strong>Immigration Status</strong></h1></td>
<td colspan="7">14. Type of Visa Card Number (if Permanent
Resident)</td>
<td colspan="4">15. Expiration Date (MM-DD-YYYY)</td>
</tr>
<tr class="odd">
<td colspan="7">           </td>
<td colspan="4">mm-dd-yyyy</td>
</tr>
<tr class="even">
<td colspan="13">16. Name of Current Employer</td>
</tr>
<tr class="odd">
<td colspan="13">     </td>
</tr>
<tr class="even">
<td colspan="13">17. Address of </td>
</tr>
<tr class="odd">
<td colspan="7">Street</td>
<td colspan="6">City</td>
</tr>
<tr class="even">
<td colspan="7">     </td>
<td colspan="6">     </td>
</tr>
<tr class="odd">
<td colspan="5">State/Province</td>
<td colspan="7">Country</td>
<td>Zip/Post Code</td>
</tr>
<tr class="even">
<td colspan="5">     </td>
<td colspan="7">     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="13">18. Title, Position, or Description of visitor’s
duties</td>
</tr>
<tr class="even">
<td colspan="13">Enter Your Job Title (i.e. Pilot, Engineer, Doctor,
etc.)</td>
</tr>
<tr class="odd">
<td colspan="7">19. Name of FAA Point of Contact <em>[sponsor]</em>
(POC)</td>
<td colspan="6">20. FAA POC <em>[sponsor]</em> Organization</td>
</tr>
<tr class="even">
<td colspan="7">Eric Simson</td>
<td colspan="6">AAM-400</td>
</tr>
<tr class="odd">
<td colspan="13">21. FAA POC <em>[sponsor]</em> Telephone Number
405-954-4837</td>
</tr>
<tr class="even">
<td colspan="13">22. Facility(ies) to be visited (include building
name/number, room number, and address of facility(ies))</td>
</tr>
<tr class="odd">
<td colspan="13"><p>CAMI (southeast temporary building), Room 124</p>
<p>6600 S. MacArthur Blvd</p>
<p>Oklahoma City, OK</p></td>
</tr>
<tr class="even">
<td colspan="13">23. AIA Approval Yes No</td>
</tr>
<tr class="odd">
<td colspan="13">24. Security Approval Yes No</td>
</tr>
</tbody>
</table>

**FAA Form 1600-78** (3-03)

+-----------------------------------+-----------------------------------+
| ######## PART B                   |                                   |
+-----------------------------------+-----------------------------------+
| 25\. Does the visit involve the   |                                   |
| exchange of any of the following  |                                   |
| categories of unclassified        |                                   |
| information?                      |                                   |
+-----------------------------------+-----------------------------------+
| a\. Sensitive Security            |                                   |
| Information? Yes No               |                                   |
+-----------------------------------+-----------------------------------+
| b\. Product or system             |                                   |
| demonstration? Yes No             |                                   |
+-----------------------------------+-----------------------------------+
| c\. Viewing, disclosure, or       |                                   |
| release of object code? Yes No    |                                   |
+-----------------------------------+-----------------------------------+
| d\. Discussion of changes to      |                                   |
| software? Yes No                  |                                   |
+-----------------------------------+-----------------------------------+
| e Viewing, disclosure, or release |                                   |
| of source code? Yes No            |                                   |
+-----------------------------------+-----------------------------------+
| f\. Examination of technical      |                                   |
| documentation? Yes No             |                                   |
+-----------------------------------+-----------------------------------+
| g\. Maintenance training? Yes No  |                                   |
+-----------------------------------+-----------------------------------+
| h\. Other (describe/explain       |                                   |
| below)? Yes No                    |                                   |
+-----------------------------------+-----------------------------------+
| **If block 25b, c, d, e, f, g, or |                                   |
| h, is marked "Yes", describe the  |                                   |
| information and/or technology     |                                   |
| involved.**                       |                                   |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| 26\. AGC-500 review (to be        |                                   |
| completed only if block 25c, d,   |                                   |
| e, f, g, h, or I is marked "Yes"  |                                   |
| )                                 |                                   |
+-----------------------------------+-----------------------------------+
| Consistent w/Export Restrictions? | Appear on Denied Persons list?    |
| Yes No                            | Yes No                            |
+-----------------------------------+-----------------------------------+

**FAA Form 1600-78** (3-03)