LPL Information/New Employee Form

Your Current/personal/non-LPL email address *

An LPL email address will not be created for visitors with a stay of 4 weeks or less (UA email and/or personal email address will be used). If you are visiting for 4 weeks or less and require an lpl email address, please indicate here. *

No - I am visiting for 4 weeks or less, but do not need an lpl email address

Yes - I am visiting for 4 weeks or less and do need an lpl email address

Visit Start Date *

Month

Day

Year

Visit End Date *

Month

Day

Year

Title *

Country of Citizenship *

Dual Citizenship? *

No

If Yes, Country

Dual Citizenship? If Yes, Country

U.S. Green Card Holder *

No

Yes

Visa Classification *

Reason for Visit *

(describe in detail)

Name of Faculty Sponsor *

Will the visitor be collaborating on sponsored research projects *

No

Yes

Which projects? *

(Include FRS #'s)

*Department Export Control Administrator (Glinda Davidson) approval is required prior to allowing a visitor to participate or have access to a sponsored project that is not identifed above.

Name of LPL employee you report to *

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LPL Information/New Employee Form