Form DHS Form 9038 DHS Form 9038 NICCS Vetting Form

Cybersecurity Education & Awareness Office (CE&A) National Initiative for Cybersecurity Careers and Studies (NICCS) Cybersecurity Training and Education Catalog

1670-0030_NICCS Vendor Vetting Form Updated_3_FORM_v1

NICCS Vendor Vetting Form

OMB: 1670-0030

Document [docx]
Download: docx | pdf

Become A Provider

Educational Cybersecurity providers can gain exposure for their courses while supporting the national mission to educate and train the nation’s future cybersecurity workforce. Over 30,000 people visit NICCS each month, and prospective students run over 6,000 unique searches in the NICCS Education and Training Catalog, making NICCS the place to promote cybersecurity related training courses.

For organizations or academic institutions interested in listing courses, apply to become a provider today! Have any questions? Contact the NICCS Supervisory Office at [email protected]. To become a provider, please have an authorized representative complete the Provider Vetting Form below.

Provider Vetting Form

To maintain the quality of the NICCS Education and Training Catalog, the NICCS Supervisory Office (NICCS SO) has created a set of vetting criteria. This criteria ensure courses listed in the catalog are offered by organizations recognized for providing quality resources, while not excluding small or medium sized organizations.

OMB Control Number: 1670-0030

Expiration Date: 04/30/2022

View Information Collection Review

Contact Information



* The asterisk indicates a required field.

Organization Name*

Form Field Place Holder






Shape1

Organization Street Address*

Form Field Place Holder






Shape2

City*

Form Field Place Holder






Shape3

U.S. States/Territories*

Form Field Place Holder






Shape4

Zip Code (5 digit)*

Form Field Place Holder






Shape5

Organization URL*

Form Field Place Holder






Shape6

Primary Point of Contact (POC) First and Last Name*

Form Field Place Holder






Shape7

Phone (XXX XXX XXXX)*

Form Field Place Holder






Shape8

Email ([email protected])*

Form Field Place Holder






Shape9

Alternate POC First and Last Name*

Form Field Place Holder






Shape10

Alternate POC Phone

Form Field Place Holder






Shape11

Alternate POC Email Address

Form Field Place Holder






Shape12

Provider Qualifications

This section assists the NICCS SO to review provider qualification

Please check the option that applies to your organization for the NICCS SO to confirm it is a legitimate business. *

  • Your organization is a federal agency or department training provider

  • Your organization has been awarded a General Services Administration (GSA) Federal Acquisition Service Contract

  • Your organization is a designated National Center of Academic Excellence (CAE)

  • Your organization is an academic institution recognized by the U.S. Department of Education or the Council for Higher Education Accreditation (CHEA)

  • Your organization is a legitimate business that meets all the following:

    Form Field Place Holder






    • Holds a business entity license in the United States, Select State (Required for this option): Shape13

    • Been in business for at least one year, and

    • Conducted or delivered training course(s) at least two (2) times over an 18-month period.

Please check all the below that are performed by your organization. *

  • Measure course effectiveness

  • Measure student review and feedback

  • Regularly evaluates ongoing curriculum development and course modification

  • Completes analysis of effectiveness of changes implemented

  • Tracks student completion information and maintains this information for at least 3 years

  • Delivers a certificate upon successful completion of the course.

Provider Acknowledgements

To be considered for inclusion on the NICCS Education and Training Catalog, potential providers must acknowledge CISA’s exclusion criteria and rights by reviewing the below and checking the corresponding check box.

Check the box below to demonstrate acknowledgement of CISA’s exclusion criteria*

  • By Checking this box, the organization acknowledges that they will be removed from the Training Catalog if any of the following events occur:

    • Your organization listed inaccurate or incorrect information in your submission,

    • Your organization has had a serious complaint lodged against it with any regulatory body,

    • Your organization denies service on the basis of color, race, religion, gender, sexual orientation, ancestry, nationality, or on any other basis not permitted by law,

    • Your organization promotes or provides services which are unlawful,

    • Your organization misrepresents, by omission or commission, pertinent facts regarding their services, organizational structure, or any other pertinent matter,

    • Your organization fails to respond to requests from the NICCS SO, or

    • Your organization links to a site that exhibits hate, bias, discrimination, pornography, libelous or otherwise defamatory content.

Check the box below to demonstrate acknowledgement of CISA’s right to deny or remove training providers from the NICCS Education and Training Catalog*

  • By checking this box, the organization acknowledges that CISA and the NICCS SO maintains the right to deny or remove training providers and content from the NICCS Education and training Catalog for the following reasons:

    • The linked website contains misleading information or unsubstantiated claims or is determined to be in conflict with CISA's mission or policies

    • The linked website fails to meet NICCS requirements for appearing in the Training Catalog

    • At CISA's sole discretion

Check the box below to demonstrate acknowledgement of CISA’s endorsement policy

  • By checking this box, the organization acknowledges that presence in the NICCS Education and Training Catalog DOES NOT imply an endorsement of any specific commercial products, processes, or services.

Your participation in the NICCS Catalog does give you permission to use the Department of Homeland Security (DHS) Seal or CISA Logo. Furthermore, your participation in the Catalog does not imply an endorsement from DHS or CISA.  Unauthorized use of the Seal/Logo or false statements of endorsement may result in removal from the Catalog.

Check the box below to demonstrate acknowledgement of CISA’s dispute procedures

  • If a complaint is lodged against you, CISA will send you a written Notice along with any pertinent evidence. You have 15 days from the date marked on the Notice to respond. Once we have received your response, the matter will be reviewed by CISA. CISA will send you a Final Decision within 30 days of receipt of your response. If the complaint is found to be persuasive, your participation in the Catalog could be suspended or terminated.

The following is to be completed by an authorized representative of the provider.

I acknowledge I have read and understood the contents of this application, and have been given full opportunity to discuss the implications of this content with any and all decision makers of my organization. I also acknowledge that the information above is truthful and accurate.

Authorized Representative Name (Last, First)*

Form Field Place Holder






Shape14

Authorized Representative Title*

Form Field Place Holder






Shape15

Submission Date*

Form Field Place Holder






Shape16



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMartz, Britney (CTR)
File Modified0000-00-00
File Created2021-01-13

© 2024 OMB.report | Privacy Policy