Safeguarding Classified and Sensitive But Unclassified Information ...

U.S. Department of Homeland Security
COURIER AUTHORIZATION REQUEST
REQUEST THE FOLLOWING NAMED INDIVIDUAL BE ISSUED COURIER AUTHORIZATION AS IDENTIFIED BELOW:
AUTHORIZATION TYPE (CHECK ONE):
LAMINATED COURIER CARD
ONE-TIME COURIER AUTHORIZATION
NAME OF COURIER: GRADE: SOCIAL SECURITY NUMBER:
TITLE:
PHONE NUMBER:
ASSIGNED ACTIVITY (INCLUDE MAILING ADDRESS):
SECURITY CLEARANCE LEVEL (CHECK ONE):
CONFIDENTIAL SECRET TOP SECRET SCI
1 HIGHEST CLASSIFICATOIN OF MATERIAL TO BE TRANSPORTED (CHECK ONE):
CONFIDENTIAL SECRET TOP SECRET SCI
AUTHORIZED GEOGRAPHIC AREA (E.G., NATIONAL CAPITAL REGION):
DATE AUTHORIZATION REQUIRED (FOR ONE-TIME TRANSPORT ONLY):
JUSTIFICATION:
NAME:
SIGNATURE:
AUTHORIZING OFFICIAL (SUPERVISOR/MANAGER/COTR)
TITLE:
DATE:
SECURITY CLEARANCE VERIFIED BY:
COMPLETED BY SECURITY OFFICE
1 The level requested for transport must be equal to or less than the security clearance level. The level requested for
transport should reflect the actual need as opposed to the security clearance level. For example, because a person has a
Top Secret security clearance does not mean they need to transport Top Secret materials – the need may be for only
Secret. Therefore, the transport level requested should be Secret.
DHS Form 11000-2 (08/03)
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