APS Visitor Registration Form    

A visitor is an individual who requires short-term site access (e.g., a meeting with staff, a conference/workshop attendee or speaker, tour group member) and will NOT conduct any hands-on work of any kind. For assistance, contact the APS User Office by e-mail at apsuser@anl.gov or by phone at (630) 252-9090 during normal business hours.

Non-US citizens: DO NOT begin until you have your immigration and naturalization documents available that establishes both your identity and legal immigration status (e.g., passport, visa, EAD card, I-20, DS-2019, I-797, or any other supplemental status documentation required to confirm your identity and legal immigration status). The Department of Energy also requires current and complete CVs/resumes in PDF format to accompany the registration form. For more details click here.

* indicates required field

Title: 
First Name*: 
Middle Initial/Name*: (if no middle name, use NMI)
Last Name*: 
Organization*: 
Type of Business*:
Department 
Address 1*: 
Address 2: 
City*: 
State/Province*: 
Zip Code*: 
Country*: 
Phone*: 
Employment Level*:
 
If you chose "Other" as your "Employment Level" please provide details here:
Cell Phone*: 
(if Yes, I have one) Cell Phone #: 
E-mail Address*: 
Sex*: 
Country of Citizenship*: 

An LPR/EAD card does not indicate U.S. Citizenship. It denotes permanent residence status.


Field of Research*:
Purpose of Visit*: 
Who are you visiting?*: 
Desired Start Date*:
Desired End Date*:
Emergency Contact name*: 
Phone Number of Emergency Contact* (999-999-9999): 
Email Address of Emergency Contact*: 
NOTE: Numbers AND expiration dates for passport, visa, LPR card, AND in-status documents such as DS-2019, I-20, I-797 are required. Proof of Visa applications are required if in-status documents have expired.

Birth Date*:
City of Birth*:
Country of Birth*:
Educational Background* MUST provide each higher-education degree completed (BS, MS, PhD - include years obtained and names of institutions)
 
Degree Name of University or College Year degree conferred
Please indicate if you have Baccalaureate Degree or not
 
Please indicate if you have Master Degree or not
 
Please indicate if you have Doctorate Degree or not
 

Identify which of the following you hold:
Select your legal file type*:
LPR (legal permanent resident-green card holder)
LPR Number
LPR Expiration Date
EAD-STEM OPT Number
EAD-STEM OPT Expiration Date
EAD Number
EAD Expiration Date

PASSPORT
Passport Number*:
Passport Country of Issue*:
Passport Expiration Date*:

VISA
Visa Type*:
Visa Number* (upper corner 200XXXXXX):
Visa Expiration Date*:
Institution Sponsoring the Visa Document*:

Other required form of identification*:
USCIS Form Number*:
Expiration Date on USCIS Form*:
Visitor Information - CV
All CVs must include
  • Include full name at the top of the page. Include your address, e-mail address, and phone number(s).
  • CVs must include all employment activities since the age of 18 years with no unexplained gaps in time over the past 10 years. If there is a gap of 6 months or more, reasoning for gap is required (i.e., layoff, unemployed, extended vacation, starting family, etc.).
  • A description of your research/science interests and technology specialties.
  • CVs must include the current/accurate name of all academic institutions attended and all degrees/diplomas with years earned.
  • All publications (if you have no publications, please indicate).
  • Do not include any Personally Identifiable Information (PII) on your CV (i.e., Date of Birth, City of Birth, etc.)
Please upload a current and complete CV/resume with your registration  
Click here to upload file  
 

    By submission of this form, I certify that the information provided herein is true, accurate, and complete.

    Click button ONCE when finished 

   Note: Do not use the "back" button to get back to this form.