+----------------------------------+---+---+-----------------------------------+
| **APPLICATION FOR DOD            |   |   |                                   |
| PERSONNEL**                      |   |   |                                   |
|                                  |   |   |                                   |
| **COUNTRY CLEARANCE REQUEST FOR  |   |   |                                   |
| ITALY\                           |   |   |                                   |
| (Upon completion, please send as |   |   |                                   |
| attachment to                    |   |   |                                   |
| [ODC-Cle                         |   |   |                                   |
| arances@mail.usembassy.it](mailt |   |   |                                   |
| o:ODC-Clearance@usembassy.it))** |   |   |                                   |
+----------------------------------+---+---+-----------------------------------+
| **SECTION 1**                    |   |   | 1A. Requesting Agency Name        |
|                                  |   |   |                                   |
| **REQUESTING AGENCY              |   |   | **     **                         |
| INFORMATION**                    |   |   |                                   |
+----------------------------------+---+---+-----------------------------------+
| 1B. Request POC Name (Last,      |   |   | 1C. POC Phone Number (include     |
| First, MI)                       |   |   | country code)                     |
|                                  |   |   |                                   |
| **     **                        |   |   | **     **                         |
+----------------------------------+---+---+-----------------------------------+
| 1D. Request POC E-Mail address   |   |   | 1E. Requesting Agency Address     |
|                                  |   |   |                                   |
| **     **                        |   |   | **     **                         |
+----------------------------------+---+---+-----------------------------------+
| **SECTION 2**                    |   |   | 2A. In-Country Arrival &          |
|                                  |   |   | Departure Dates                   |
| **VISIT & TRAVEL INFORMATION**   |   |   |                                   |
|                                  |   |   | Arrival: **     **                |
|                                  |   |   |                                   |
|                                  |   |   | Departure: **     **              |
+----------------------------------+---+---+-----------------------------------+
| 2B. VISIT Location & Dates       |   |   | 2C. Italian MIL, GVT or Industry  |
| (Include Complete Address)       |   |   | Contact Anticipated?              |
|                                  |   |   |                                   |
| Location: **     **              |   |   | YES                               |
|                                  |   |   |                                   |
| Date(s): **     **               |   |   | NO                                |
+----------------------------------+---+---+-----------------------------------+
| 2D. Visit Location POC Name      |   |   | 2E. Visit Location POC(s) Phone   |
| (Last, First, MI)                |   |   | Number(s)                         |
|                                  |   |   |                                   |
| **     **                        |   |   | **     **                         |
+----------------------------------+---+---+-----------------------------------+
| 2F. Italian Visit POC Name &     |   |   | 2G. Italian Visit POC(s) Phone    |
| Rank (Last, First, MI)           |   |   | Number(s)                         |
|                                  |   |   |                                   |
| **     **                        |   |   | **     **                         |
+----------------------------------+---+---+-----------------------------------+
| 2H. Classification Level of      |   |   | 2I. Visit Is:                     |
| Discussion Anticipated           |   |   |                                   |
|                                  |   |   | BY ITALIAN INVITATION             |
| **     **                        |   |   |                                   |
|                                  |   |   | U.S. DOD/GVT INITIATIVE           |
+----------------------------------+---+---+-----------------------------------+
| 2J. Detailed Purpose of Visit:   |   |   |                                   |
|                                  |   |   |                                   |
| **     **                        |   |   |                                   |
+----------------------------------+---+---+-----------------------------------+
| **SECTION 3**                    |   |   |                                   |
|                                  |   |   |                                   |
| **FOR INDUSTRY VISIT ONLY**      |   |   |                                   |
+----------------------------------+---+---+-----------------------------------+
| 3A. VISIT IS PERTINENT TO:       | 3 |   |                                   |
|                                  | B |   |                                   |
| A SPECIFIC EQUIPMENT OR WEAPON   | . |   |                                   |
| SYSTEM                           | S |   |                                   |
|                                  | P |   |                                   |
| FOREIGN MILITARY SALES OR EXPORT | E |   |                                   |
| LICENSE                          | C |   |                                   |
|                                  | I |   |                                   |
| A PROGRAM OR AGREEMENT           | F |   |                                   |
|                                  | Y |   |                                   |
| A DEFENSE ACQUISITION PROGRAM    | D |   |                                   |
|                                  | E |   |                                   |
| OTHER                            | T |   |                                   |
|                                  | A |   |                                   |
|                                  | I |   |                                   |
|                                  | L |   |                                   |
|                                  | S |   |                                   |
|                                  | O |   |                                   |
|                                  | F |   |                                   |
|                                  | P |   |                                   |
|                                  | R |   |                                   |
|                                  | O |   |                                   |
|                                  | G |   |                                   |
|                                  | R |   |                                   |
|                                  | A |   |                                   |
|                                  | M |   |                                   |
|                                  |   |   |                                   |
|                                  | * |   |                                   |
|                                  | * |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  | * |   |                                   |
|                                  | * |   |                                   |
+----------------------------------+---+---+-----------------------------------+
| **SECTION 4**                    |   |   |                                   |
|                                  |   |   |                                   |
| **VISITOR INFORMATION**          |   |   |                                   |
+----------------------------------+---+---+-----------------------------------+
| NAME: **     **                  |   | D |                                   |
|                                  |   | A |                                   |
| RANK/GRADE: **     **            |   | T |                                   |
|                                  |   | E |                                   |
| COMPANY: **     **               |   | O |                                   |
|                                  |   | F |                                   |
| TITLE: **     **                 |   | B |                                   |
|                                  |   | I |                                   |
| SSN: **     **                   |   | R |                                   |
|                                  |   | T |                                   |
| SECURITY CLEARANCE: **     **    |   | H |                                   |
|                                  |   | : |                                   |
| AT/FP TNG DATE: **     **        |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | P |                                   |
|                                  |   | L |                                   |
|                                  |   | A |                                   |
|                                  |   | C |                                   |
|                                  |   | E |                                   |
|                                  |   | O |                                   |
|                                  |   | F |                                   |
|                                  |   | B |                                   |
|                                  |   | I |                                   |
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|                                  |   | T |                                   |
|                                  |   | H |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | N |                                   |
|                                  |   | A |                                   |
|                                  |   | T |                                   |
|                                  |   | I |                                   |
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|                                  |   | L |                                   |
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|                                  |   | T |                                   |
|                                  |   | Y |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | P |                                   |
|                                  |   | A |                                   |
|                                  |   | S |                                   |
|                                  |   | S |                                   |
|                                  |   | P |                                   |
|                                  |   | O |                                   |
|                                  |   | R |                                   |
|                                  |   | T |                                   |
|                                  |   | N |                                   |
|                                  |   | U |                                   |
|                                  |   | M |                                   |
|                                  |   | B |                                   |
|                                  |   | E |                                   |
|                                  |   | R |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
+----------------------------------+---+---+-----------------------------------+
| NAME: **     **                  |   | D |                                   |
|                                  |   | A |                                   |
| RANK/GRADE: **     **            |   | T |                                   |
|                                  |   | E |                                   |
| COMPANY: **     **               |   | O |                                   |
|                                  |   | F |                                   |
| TITLE: **     **                 |   | B |                                   |
|                                  |   | I |                                   |
| SSN: **     **                   |   | R |                                   |
|                                  |   | T |                                   |
| SECURITY CLEARANCE: **     **    |   | H |                                   |
|                                  |   | : |                                   |
| AT/FP TNG DATE: **     **        |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | P |                                   |
|                                  |   | L |                                   |
|                                  |   | A |                                   |
|                                  |   | C |                                   |
|                                  |   | E |                                   |
|                                  |   | O |                                   |
|                                  |   | F |                                   |
|                                  |   | B |                                   |
|                                  |   | I |                                   |
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|                                  |   | T |                                   |
|                                  |   | H |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | N |                                   |
|                                  |   | A |                                   |
|                                  |   | T |                                   |
|                                  |   | I |                                   |
|                                  |   | O |                                   |
|                                  |   | N |                                   |
|                                  |   | A |                                   |
|                                  |   | L |                                   |
|                                  |   | I |                                   |
|                                  |   | T |                                   |
|                                  |   | Y |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | P |                                   |
|                                  |   | A |                                   |
|                                  |   | S |                                   |
|                                  |   | S |                                   |
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|                                  |   | E |                                   |
|                                  |   | R |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
+----------------------------------+---+---+-----------------------------------+
| NAME: **     **                  |   | D |                                   |
|                                  |   | A |                                   |
| RANK/GRADE: **     **            |   | T |                                   |
|                                  |   | E |                                   |
| COMPANY: **     **               |   | O |                                   |
|                                  |   | F |                                   |
| TITLE: **     **                 |   | B |                                   |
|                                  |   | I |                                   |
| SSN: **     **                   |   | R |                                   |
|                                  |   | T |                                   |
| SECURITY CLEARANCE: **     **    |   | H |                                   |
|                                  |   | : |                                   |
| AT/FP TNG DATE: **     **        |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | P |                                   |
|                                  |   | L |                                   |
|                                  |   | A |                                   |
|                                  |   | C |                                   |
|                                  |   | E |                                   |
|                                  |   | O |                                   |
|                                  |   | F |                                   |
|                                  |   | B |                                   |
|                                  |   | I |                                   |
|                                  |   | R |                                   |
|                                  |   | T |                                   |
|                                  |   | H |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | N |                                   |
|                                  |   | A |                                   |
|                                  |   | T |                                   |
|                                  |   | I |                                   |
|                                  |   | O |                                   |
|                                  |   | N |                                   |
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|                                  |   | L |                                   |
|                                  |   | I |                                   |
|                                  |   | T |                                   |
|                                  |   | Y |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | P |                                   |
|                                  |   | A |                                   |
|                                  |   | S |                                   |
|                                  |   | S |                                   |
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|                                  |   | O |                                   |
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|                                  |   | M |                                   |
|                                  |   | B |                                   |
|                                  |   | E |                                   |
|                                  |   | R |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
+----------------------------------+---+---+-----------------------------------+
| NAME: **     **                  |   | D |                                   |
|                                  |   | A |                                   |
| RANK/GRADE: **     **            |   | T |                                   |
|                                  |   | E |                                   |
| COMPANY: **     **               |   | O |                                   |
|                                  |   | F |                                   |
| TITLE: **     **                 |   | B |                                   |
|                                  |   | I |                                   |
| SSN: **     **                   |   | R |                                   |
|                                  |   | T |                                   |
| SECURITY CLEARANCE: **     **    |   | H |                                   |
|                                  |   | : |                                   |
| AT/FP TNG DATE: **     **        |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
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|                                  |   | L |                                   |
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|                                  |   | C |                                   |
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|                                  |   | B |                                   |
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|                                  |   | H |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
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|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
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|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
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|                                  |   | : |                                   |
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|                                  |   | A |                                   |
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|                                  |   | E |                                   |
|                                  |   | R |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
+----------------------------------+---+---+-----------------------------------+
| NAME: **     **                  |   | D |                                   |
|                                  |   | A |                                   |
| RANK/GRADE: **     **            |   | T |                                   |
|                                  |   | E |                                   |
| COMPANY: **     **               |   | O |                                   |
|                                  |   | F |                                   |
| TITLE: **     **                 |   | B |                                   |
|                                  |   | I |                                   |
| SSN: **     **                   |   | R |                                   |
|                                  |   | T |                                   |
| SECURITY CLEARANCE: **     **    |   | H |                                   |
|                                  |   | : |                                   |
| AT/FP TNG DATE: **     **        |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | P |                                   |
|                                  |   | L |                                   |
|                                  |   | A |                                   |
|                                  |   | C |                                   |
|                                  |   | E |                                   |
|                                  |   | O |                                   |
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|                                  |   | B |                                   |
|                                  |   | I |                                   |
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|                                  |   | H |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | N |                                   |
|                                  |   | A |                                   |
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|                                  |   | I |                                   |
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|                                  |   | Y |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | P |                                   |
|                                  |   | A |                                   |
|                                  |   | S |                                   |
|                                  |   | S |                                   |
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|                                  |   | E |                                   |
|                                  |   | R |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
+----------------------------------+---+---+-----------------------------------+
| NAME: **     **                  |   | D |                                   |
|                                  |   | A |                                   |
| RANK/GRADE: **     **            |   | T |                                   |
|                                  |   | E |                                   |
| COMPANY: **     **               |   | O |                                   |
|                                  |   | F |                                   |
| TITLE: **     **                 |   | B |                                   |
|                                  |   | I |                                   |
| SSN: **     **                   |   | R |                                   |
|                                  |   | T |                                   |
| SECURITY CLEARANCE: **     **    |   | H |                                   |
|                                  |   | : |                                   |
| AT/FP TNG DATE: **     **        |   | * |                                   |
|                                  |   | * |                                   |
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|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | P |                                   |
|                                  |   | L |                                   |
|                                  |   | A |                                   |
|                                  |   | C |                                   |
|                                  |   | E |                                   |
|                                  |   | O |                                   |
|                                  |   | F |                                   |
|                                  |   | B |                                   |
|                                  |   | I |                                   |
|                                  |   | R |                                   |
|                                  |   | T |                                   |
|                                  |   | H |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
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|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | N |                                   |
|                                  |   | A |                                   |
|                                  |   | T |                                   |
|                                  |   | I |                                   |
|                                  |   | O |                                   |
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|                                  |   | T |                                   |
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|                                  |   | * |                                   |
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|                                  |   | * |                                   |
|                                  |   |   |                                   |
|                                  |   | P |                                   |
|                                  |   | A |                                   |
|                                  |   | S |                                   |
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|                                  |   | O |                                   |
|                                  |   | R |                                   |
|                                  |   | T |                                   |
|                                  |   | N |                                   |
|                                  |   | U |                                   |
|                                  |   | M |                                   |
|                                  |   | B |                                   |
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|                                  |   | R |                                   |
|                                  |   | : |                                   |
|                                  |   | * |                                   |
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|                                  |   |   |                                   |
|                                  |   |   |                                   |
|                                  |   | * |                                   |
|                                  |   | * |                                   |
+----------------------------------+---+---+-----------------------------------+