U.S. Department of Health & Human Services | National Institutes of Health
SHUTTLE PASS REQUEST FORM
PLEASE COMPLETE AND SUMBIT TO NCISHADYGROVESHUTTLE@MAIL.NIH.GOV.
Requestor Name: _________________________________________________________________
Sponsor’s Name: __________________________________________________________________
Sponsor’s ORG: ___________________________________________________________________
Building _________________ Room ______________________ MSC ________________________
Program AO Name: ________________________________________________________________
Visitor’s Name: ____________________________________________________________________
Visitors ORG: ______________________________________________________________________
*Duraon of Visit: From__________________________ To ________________________________
*DURATION NOT TO EXCEED 30 DAYS *
Please note that the NCI Shule’s and Garage Parking are for NCI employee’s, guest and ocial
government business ONLY
NCI Shady Grove Shuttle Visitor Pass
assengers are required to show proper NI badging prior to riding the NCI Shady Grove Shuttles.
isitors who anticipate on riding the NCI Shady Grove Shuttles need to secure a visitor shuttle pass
from their sponsor. Sponsors must fill out the request form below and submit it to
firstname.lastname@example.org. Shuttle visitor passes are issued for a period of days or less.
Upon verification of the completed form, visitor passes will be printed and provided to the sponsor
at the front desk in the lobby of the Shady Grove Facility. If requested, visitor passes can be delivered
to a sponsor that is not located at Shady Grove through interoffice mail.
It is the sponsor's responsibility to ensure their visitors have received shuttle passes prior to their
visit and transport on NCI Shady Grove Shuttles.
If you have any questions, please contact Gehmelle Johnson at email@example.com.