ISMO International Fellows Personal Information Collection

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 30 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.

Version 1.1 – Effective 7/18/2017

PRIVACY ACT STATEMENT

OMB Control #
Expiration Date

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-SORNArticle-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.
______________________________________________________________
______________________________________________________________
______________________________________________________________
(End of Page 1 )

Biographical Data
Country:
____________________
First and Last Name:
____________________
What languages do you speak? Please list all.
____________________
Please list your last three assignments/postings and years in each assignment
(Example: Director, J5; 2011-2016)
Most Recent ________________________________________
2nd Most Recent ________________________________________
3rd Most Recent ________________________________________
Please list three of your personal hobbies (ex. hunting, reading, riding horses, playing
soccer)
____________________
Have you attended training in the US before?
 Yes
 No
If you answered yes to the above, please list the training courses you completed in the
US, including date and location. (Example: Command and General Staff College, Fort
Leavenworth, August 2017-June 2018)
____________________
Do you smoke?
 Yes
 No
(End of Page 2 )

Family Members
While our office unfortunately cannot grant authorization for your dependents on your
ITO, we understand they may nevertheless join you in country on individually-arranged
visas. Your family members (dependents) will:
 NOT be joining me.
 join me for a short time, such as vacation, holiday, or for an anniversary
 join me for the entire year in the United States
If your dependents are joining you for over 75% of the year (for 8 months or MORE),
please list them by relationship, date of birth, and their tentative arrivals and
departures. (Example: Spouse, 14 August 1975, 5 July 2020 - 28 May 2021)
______________________________________________________________
______________________________________________________________
______________________________________________________________
(End of Page 3 )

Community Sponsor Program
The International Student Management Office manages a Community Sponsor Program
designed to offer support and assistance to International Fellows studying at National
Defense University. As an International Fellow (IF), you will have the opportunity to
participate in this program and establish a meaningful relationship with an assigned
sponsor and his/her family in such a way that both parties benefit from this unique
international interaction.
Community Sponsors are local community members from all walks of life who join our
program in order to befriend International officers, assist in the transition to the U.S.,
learn about different cultures, offer insight into U.S. culture, and ensure that your
experience at NDU and in the United States is a positive one. Participating in the NDU
Sponsorship Program is a rich and rewarding experience, as the relationship you
develop with your Sponsor can last a lifetime.
Would you like to participate in the Community Sponsor Program and be matched with
a sponsor?
 Yes
 No
(End of Page 4 )