CISA Out-Processing Information Form

DEPARTMENT OF DEFENSE
NATIONAL DEFENSE UNIVERSITY
COLLEGE OF INTERNATIONAL SECURITY AFFAIRS
WASHINGTON, D.C. 20319-5066

CLASS OF [INSERT YEAR HERE]:
OFFICIAL THESIS TITLE, GRADUATION,
& OUT-PROCESSING INFORMATION
For end of the year activities (Thesis Symposium, CISA Out-Processing, and Graduation),
CISA will need to gather information from you to streamline these efforts. This is one short
form that requires completion.
1. The NDU Graduation name confirmation: Please provide the correct spelling of your
title/rank and your first & last names as it should appear on your diploma. This information
will also be used in conjunction with the Thesis Symposium materials. If there are
questions regarding the name confirmation, please speak with CISA Registrar Ms. Sheila
DeTurk.
2. Your official thesis title: Please provide the official title of your thesis, required for
symposium panel grouping and for the symposium’s program. Note that we are unable to
make changes to the symposium materials once they are sent to the printer. If there are
questions regarding the official thesis title, please speak with Dr. Rameez Abbas or Ms.
Brianna Harwart.
3. NDU Alumni Email Account/Staying Connected: Upon graduation, NDU provides
all its graduates with a lifetime email account. The CISA alumni office was established to
provide assistance for post-graduation requests and keep its graduates connected via a
monthly e-newsletter, mobile education trainings, online educational resources, and an
annual NDU alumni security seminar. If you have any questions regarding the CISA
alumni program or your alumni email account, please contact Ms. Faith Ssebikindu at
[email protected].

DEPARTMENT OF DEFENSE
NATIONAL DEFENSE UNIVERSITY
COLLEGE OF INTERNATIONAL SECURITY AFFAIRS
WASHINGTON, D.C. 20319-5066

PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 2165, National Defense University; 10 U.S.C. 2163 Degree
Granting Authority for National Defense University and E.O. 9397, as amended (SSN).
PURPOSE: The data provided will be used to update your National Defense University
(NDU) record. NDU data are used to authenticate and identify NDU personnel and
students; track academic enrollment, assignments, progress, and assessments; track
personnel records and actions; create academic transcripts and related reports; facilitate
award of degrees and credentials; conduct analysis for regional and DoD academic
accreditations; and create reports for University leadership to aid in the development of
effective curricula, facilitate academic completion requirements.
ROUTINE USES: Data are shared with other Federal/State agencies and contractors for
the purpose of communicating educational credentials and accrediting University
programs. For a complete list of routine uses and authorities see the applicable system of
records notice, National Defense University (NDU) Student Data Files (September 21,
2010, 75 FR 57458). The notice is located at: https://dpcld.defense.gov/Privacy/
SORNsIndex/DOD-wide-SORN-Article-View/Article/570570/dndu01/
DISCLOSURE: Voluntary. However, if data in NDU systems are not up-to-date,
your NDU entitlements/privileges and the ability of NDU systems to identify you as an
NDU-affiliated person could be delayed or inaccurate. The production of accurate
academic transcripts may not be possible. Home addresses will be used for mustering in
the event of an officially declared manmade or natural disaster (DoDI 3001.02) and for
notification of a Privacy compromise, loss or stolen (breached) personally identifiable
information (PII). If addresses are not correct these two requirements will not be
performed with accuracy as to your location.

DEPARTMENT OF DEFENSE
NATIONAL DEFENSE UNIVERSITY
COLLEGE OF INTERNATIONAL SECURITY AFFAIRS
WASHINGTON, D.C. 20319-5066

OMB CONTROL NUMBER: XXXX-XXXX
OMB EXPIRATION DATE: XX/XX/XXXX
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, [Insert OMB Control
Number], is estimated to average 10 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information. Send comments regarding the
burden estimate or burden reduction suggestions to the Department of Defense,
Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other
provision of law, no person shall be subject to any penalty for failing to comply with a
collection of information if it does not display a currently valid OMB control number

DEPARTMENT OF DEFENSE
NATIONAL DEFENSE UNIVERSITY
COLLEGE OF INTERNATIONAL SECURITY AFFAIRS
WASHINGTON, D.C. 20319-5066

Academic Program:
___ RDFP
___ SCAP
___ JSOMA
___ RDFP Part-Time
___ SCAP Part-Time
Name as listed on Diploma:
Please DO NOT provide a rank. Please DO NOT type in all CAPS- use regular
upper and lower case, as provided in the example below.
Examples of format: John R. Smith | John Robert Smith | John Smith
________________________________________________________________________
________________________________________________________________________
Name appearance as listed in Commencement Program:
Provide rank, branch of service/agency, and country. Please provide last name
(in CAPS), then first name (Sentence Case).
Examples of format: SMITH, John, MAJ, United States Army | SMITH, John
Thomas, Department of State
________________________________________________________________________
________________________________________________________________________
Rank abbreviation for Thesis Symposium program & Alumni Records:
Please ensure the proper capitalization and appearance of your rank, especially
the International Fellows.
Examples of format: LTC | LtCol | Mr. | AMB
________________________________________________________________________
________________________________________________________________________
FIRST and LAST name appearance in Thesis Symposium program:
Even if this is the same as the Commencement program name confirmation,
please provide again for verification.
Examples of format: John R. Smith | John Robert Smith | John Smith
________________________________________________________________________
________________________________________________________________________

DEPARTMENT OF DEFENSE
NATIONAL DEFENSE UNIVERSITY
COLLEGE OF INTERNATIONAL SECURITY AFFAIRS
WASHINGTON, D.C. 20319-5066

Branch of service or agency:
Example: U.S. Army | Department of State | Ministry of Internal Affairs
________________________________________________________________________
________________________________________________________________________
Country:
________________________________________________________________________
________________________________________________________________________
Official Thesis Title:
________________________________________________________________________
________________________________________________________________________
What is your preferred non-NDU email address?
________________________________________________________________________
________________________________________________________________________
What is your non-NDU telephone number?
Please provide the area code/country code. If you are unable to respond due to
security concerns, please state that in the text field below.
________________________________________________________________________
________________________________________________________________________
Phone Type:
___ Home
___ Mobile
___ Office
___ Other
What was your pre-CISA position?
Please provide your position title, assignment location, and brief description of
the level of responsibility. If you are unable to respond due to security concerns,
please state that in the text field below.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

DEPARTMENT OF DEFENSE
NATIONAL DEFENSE UNIVERSITY
COLLEGE OF INTERNATIONAL SECURITY AFFAIRS
WASHINGTON, D.C. 20319-5066

What is/will be your post-CISA position?
Please provide your position title, assignment location, and brief description of
the level of responsibility. If you are unable to respond due to security concerns,
please state that in the text field below.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Are you expecting to be promoted after your graduation from CISA?
Is your post-CISA assignment a promotion? If you are unable to respond due to
security concerns, please select N/A below.
___ Yes
___ No
___ N/A
How can CISA support your professional development?
Please be as specific/descriptive as possible.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Alumni Communications: Would you like to be added to the Washington D.C. CISA
events distribution group?
___Yes
___No
Would you like to receive an NDU Alumni email account?
___YES, I would like to receive an NDU Alumni email account.
___NO, I would NOT like to receive an NDU alumni email account.