AMEDDApplicantWorksheet-July2012-3.doc

While traveling to or in this country were you

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While traveling to or in this country, were you involved in any encounter with the police? While traveling to or in this country, were you contacted by, or in contact with any person known or suspected of being involved or associated with foreign intelligence, terrorist, security, or military organizations? While traveling to, or in this country, were you involved in any counter intelligence or security issues not reported? While traveling to or in this country, were you contacted by, or in contact with anyone exhibiting excessive knowledge of or undue interest in you or your job? While traveling to or in this country, were you contacted by, or in contact with anyone attempting to obtain classified information or unclassified, sensitive information? While traveling to, or in this country, were you threatened, coerced, or pressured in any way to cooperate with a foreign government official or foreign intelligence or security service? 40
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From Date (dd-MMM-yyyy): To Date (dd-MMM-yyyy): Purpose of Visit : Business/Professional Conference Education Other Tourism Visit family or friends Volunteer Activities Country Visited: Number of days involved in the visit: While traveling to, or in this country, were you questioned, searched, or otherwise detained (other than for normal customs requirements) by the local customs or security service officials when entering or leaving this country? While traveling to or in this country, were you involved in any encounter with the police? While traveling to or in this country, were you contacted by, or in contact with any person known or suspected of being involved or associated with foreign intelligence, terrorist, security, or military organizations? While traveling to, or in this country, were you involved in any counter intelligence or security issues not reported? While traveling to or in this country, were you contacted by, or in contact with anyone exhibiting excessive knowledge of or undue interest in you or your job? While traveling to or in this country, were you contacted by, or in contact with anyone attempting to obtain classified information or unclassified, sensitive information? While traveling to, or in this country, were you threatened, coerced, or pressured in any way to cooperate with a foreign government official or foreign intelligence or security service? From Date (dd-MMM-yyyy): To Date (dd-MMM-yyyy): Purpose of Visit : Business/Professional Conference Education Other Tourism Visit family or friends Volunteer Activities Country Visited: Number of days involved in the visit: While traveling to, or in this country, were you questioned, searched, or otherwise detained (other than for normal customs requirements) by the local customs or security service officials when entering or leaving this country?
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