This form is for dependent access to the United States Naval Academy (USNA) complex. Prior authorization is required to submit this form.
To get started, follow these instructions in their entirety:
- Adobe Acrobat Reader must be used to access and complete this form.
- All forms must be typed, handwritten forms are not accepted.
- Incomplete forms cannot be processed.
Page 1 Instructions:
Block #
1. Type your Last Name
2. Type your First Name
3. Type your Middle Name
5. Race: check one or more boxes
7. Type Date of Birth (MM/DD/YYYY)
8. Type City of Birth
9. Type State of Birth
10. Type Birth Country (example: USA)
11. US Citizen: check Yes or No (if NO, complete blocks 14-18 for Alien Registration No.)
12. Dual Citizenship: check Yes or No (if No for Block 11, and/or Yes for Block 12, provide country)
13. Two (2) Identity Sources are required:
| A . Social Security – Required |
| 14. Type Document Number |
| B. Driver’s License – Required. Blocks 14 – 18 are required |
| 14. Type Document Number 15. Type State/Court where Identity Source was issued 17. Type Issue Date of Identity Source (MM/DD/YYYY) 18. Type Expiration Date of Identity Source (MM/DD/YYYY) |
| C. Passport Number – Optional |
| D. Certification Number & Petition Number – Optional |
| E. Derived – Parent’s Certification Number – Optional |
| F. Alien Registration Number – Required if you are NOT a U.S. Citizen |
| 14. Type Document Number 15. Type State/Court where Identity Source was issued 17. Type Issue Date of Identity Source (MM/DD/YYYY) 18. Type Expiration Date of Identity Source (MM/DD/YYYY) Date of Entry Port of Entry |
23. Type your Home Address, include City, State, Zip Code and Phone Number
24. Type Base Sponsor Name and Phone Number
Page 2 Instructions:
Block #
25. Type Company Name and Address, include City, State, Zip Code and Phone Number. If self-employed, put self-employed in Block 25
26. Type Supervisor Name and Address, include City, State, Zip Code and Phone Number
27. Work Hours: check one (If checked Other, provide the hours of access); Work Days: check one, or more, requesting day(s) of required of access
28. Prior Felony Convictions: check Yes or No and type your initials
29. Return DBIDS Card: Type your initials
30. Type Current Date (MM/DD/YYYY) and Hand Sign signature line *******Form must be physically signed by applicant********
Additional Instructions:
- Review all blocks for accuracy and completeness prior to submitting.
- Send form as an attachment via email to: nabsdaccess@usna.edu
An Access Team member will email you within 10 business days to inform you of your status, approved or denied, along with directions as to how to obtain your credential. Per Security, there is no expedited track for processing these forms.
REMINDER: FORMS MUST BE SUBMITTED AT LEAST 10 BUSINESS DAYS PRIOR TO REQUIRED ACCESS.