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The document is a request form (NETL F 142.1-1A) from the U.S. Department of Energy for unclassified foreign national access to DOE facilities and personnel. It outlines the purpose, authority, and privacy considerations related to collecting personal information from foreign nationals seeking access. The form requires detailed personal data, including identification documentation and educational background, particularly for visa holders. It emphasizes the importance of submitting the form with an Official Use Only cover sheet to protect personal data.

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Click ‘Get Form’ to open it in the editor.
Begin with Section A – Personal Data. Fill in Block 1a with your last name, first name, and middle name (enter 'NMN' if no middle name).
In Block 9, provide your Social Security Account Number (SSAN), which is mandatory for all foreign nationals.
For Block 10, list any other identification documentation you possess, such as a driver's license or student ID.
Complete Block 17 by listing all schools attended and their graduation dates if you hold an F-1 or J-1 Visa. Include a letter from your host school confirming full-time enrollment.
Once all fields are filled out accurately, save your document. Ensure to include the OUO Cover Sheet when submitting your completed form.

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