High-Risk Country Access Request Form
Please complete the High-Risk Country Access Request Form to request authorization for travel to a high-risk country. All fields are required to ensure a thorough review.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Organization / Department
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Destination Country
*
Please Select
Afghanistan
Iran
North Korea
Syria
Yemen
Other
Purpose of Travel
*
Intended Travel Dates
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Duration of Stay (in days)
*
Justification for Access
*
Supervisor or Manager Name
*
Submit Request
Should be Empty: