TE 2 - Forms - App for Sponsorship

APPLICATION FOR SPONSORSHIP

PRIVACY ACT STATEMENT: The information you provide is covered by the Privacy Act of 1974, Title 5, U.S.C. 552a. AUTHORITY: 10 U.S.C. 3013, Secretary of the Army; Army Regulation 190-13, The Army Physical Security Program and E.O. 9397 (SSN). PRINCIPAL PURPOSE(S): To record personal data and vehicle information to ensure positive identification of personnel authorized access to the installation/restricted areas; to conduct criminal background checks through local and national law enforcement databases; to maintain accountability for issuance and disposition of access passes. ROUTINE USES: The DoD Blanket Routine Use set forth at the beginning of the Army's compilation of systems of records notices may apply to this system. DISCLOSURE: Voluntary. However, failure to provide the requested information will result in denial of access to the installation.

Request sponsorship for the following individuals:
Last Name
First Name
Middle Initial
Date of Birth
ID Type
ID Number
ID State *See Reverse*
Citizenship
Vehicle Make
Vehicle Color
Vehicle Plate
State
Justification:

DATE OF REQUESTED ACCESS (DD/MMM/YYYY)

TIME OF REQUESTED ACCESS

FROM

FROM

TO

MONDAY

DAYS REQUESTED ACCESS

TUESDAY

WEDNESDAY

SPONSOR’S INFORMATION:

LAST NAME:

RANK/GRADE:

TO

THURSDAY

FRIDAY

SATURDAY

FIRST NAME:

SUNDAY

MI:

ORGANIZATION:

TELE:

ADDRESS:

EMAIL:

I acknowledge as a Sponsor that the name(d) individuals have official business to conduct on Fort Drum _

_

(Sponsor’s Signature)
The above individuals are approved
Badge.

Approving Official Printed Name

_
Date

/ disapproved

for issuance of Friends of the North Country Local Access

Approving Official Signature

SECTION BELOW IS FOR USE BY INSTALLATION ACCESS CONTROL OFFICE

NCIC-III DATE:

NCIC-III Officer Printed Name

IMDR-ES FORM 2, JAN 2025

CLEARED / FAILED (circle one)

NCIC-III Officer Signature

PREVIOUS EDITION IS OBSOLETE

CONTROL #

APPLICATION FOR SPONSORSHIP INSTRUCTIONS

USE: The information contained in the application will serve as input data to conduct a NCIC-III background check as required by AR 190-13. If you do not type the information on this form insure that your writing is neat and legible to avoid any mistakes, confusion, or delays when conducting checks and preparing passes.It is essential that all users of this form provide the required information according to the instructions below:
Last Name: self-explanatory.
First Name: self-explanatory.
Middle Initial: self-explanatory.
Date of Birth: DDMMMYYYY (example: 05 FEB 2025)