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Required Information

For the

Security Assurance Check (SAC) Request

(To Be Completed by Student Applicant)

Please mail or fax this information to the Student Internship Coordinator at Post.

1. Full Name: ____________________________________

2. Social Security Number: ____________________________________

3. Place of Birth (POB): ____________________________________

4. Date of Birth: ____________________________________

5. Current Street Mailing Address: ____________________________________

_____________________________________

_____________________________________

6. Phone Number: _____________________________________

7. E-Mail Address: _____________________________________


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  Notice to Visitors!


  The link you have chosen will take you to a non-U.S. Government website.

  If the page does not appear in 5 seconds, please click this: outside web site

  BuyUSA.gov is managed by the International Trade Administration and external links are covered by its website disclaimer statement.