DD-3067-2 Science, Mathematics, and Research for Transformation (S

Science, Mathematics and Research for Transformation (SMART) Scholarship Program

DD3067-2 DRAFT 20220701

OMB: 0704-0466

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Science, Mathematics, and Research for Transformation (SMART) Scholarship
Educational Work Plan
PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. 4093, Science, Mathematics, and Research for Transformation (SMART) Defense Education Program; 10 U.S.C. 133a, Under
Secretary of Defense for Research and Engineering; DoD Directive 5137.02, Under Secretary of Defense for Research and Engineering (USD(R&E)); DoD
Instruction 1025.09, Science, Mathematics, and Research for Transformation Defense Education Program.
PURPOSE: To record a SMART awardee’s educational work plan as a prerequisite for funding.
ROUTINE USES: While the information requested on this form is primarily intended to be used internally, in certain circumstances it may be necessary to
disclose this information externally, pursuant to 5 U.S.C. 552a(b)(3), including: to contractors, grantees, experts, consultants, students, and others performing or
working on a contract, service, grant, cooperative agreement, or other assignment for the Federal Government when necessary to accomplish an agency
function, or, to academic institutions for the purposes of providing progress reports for applicants and participants. A complete list of routine uses may be found in
the applicable Privacy Act System of Records Notice, DUSDA 14, Science, Mathematics, and Research for Transformation (SMART) Information management
System, found at https://dpcld.defense.gov/Portals/49/Documents/Privacy/SORNs/OSDJS/DUSDA-14.pdf?ver=KO2ZkLWhxB3QCZoRTElMFA%3d%3d
DISCLOSURE: Voluntary; however, failure to provide the requested information may result in SMART scholar being non-compliant with SMART policy, and
subject to possible dismissal.
The public reporting burden for this collection of information is estimated to average 1 hour 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 this
burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington
Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other
provisions 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.
Award Type:

Recruitment

Retention

Retention - Retention scholars are individuals who are employed in a full-time permanent or renewable term civilian position by the sponsoring facility at the time
of award.
Recruitment - Recruitment scholars are individuals who are not employed in a full-time permanent or renewable term civilian position by the sponsoring facility at
the time of award.
Cohort - A "cohort" refers to the group of the participants who received a SMART award in a particular year. For example, participants who received a SMART
award in 2021 are part of the 2021 cohort.

NEEDS DD67

INSTRUCTIONS: This Educational Work Plan (EWP) is a prerequisite to funding. Include all courses for your funded degree, including all past, current, and
future courses/research hours until degree completion. Transcripts, academic calendars, and other substitutions are not accepted.

SECTION 1 – Awardee Information
Name (Last, First, Middle Initial):

Cohort Year:

Phone:

Email:

SECTION 2 – Academic Information
Academic Institution:
Academic Calendar System:

Semester

Quarter

Year-Round

Advisor Name:

Advisor Email:

Date Degree Work Began (YYYYMMDD):

Field of Study (ex. Computer Science, Electrical Engineering, etc.)

Approved Degree Level to be Pursued:

BS

Graduation Project (Response Required):

BS/MS

Dissertation

MS
Thesis

PhD
Final Project/Report/Paper

No Project Required
N/A

Research/Project Title (if applicable):

TBD

Research/Project Summary (if applicable):

Transfer Credits Accepted by University (if applicable):

The 'Minimum Credits Hours Planned (per term)' must be equal to or greater than the 'Number of Credits Required for Full-Time Status (per term)'
listed below.
Number of Credits Required for Full-Time Status (per term):

DD FORM 3067-2, 20220701 DRAFT

Minimum Credit Hours Planned (per term):

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The 'Number of Credits Listed in this Plan’ must be equal to or greater than the 'Total Credits Required for Degree’ listed below.
Number of Credits Listed in this Plan:

Total Credits Required for Degree:

Degree Completion Date (YYYYMMDD):*

Degree Conferral Date (YYYYMMDD):**

Notes: *Degree Completion Date: Date on which an individual completes all degree requirements. This generally occurs prior to degree conferral and is not set
forth on official transcripts.
** Degree Conferral Date: Date on which a degree is bestowed upon an individual. This is set forth on the official transcript reflecting the degree earned
and may occur after degree completion.
By signing below, I certify that the information contained in this Educational Work Plan is true and correct.
Awardee Name:

Awardee Signature:

Date (YYYYMMDD):

SECTION 3 – Course Listing
Section Instructions:
1. List courses by term, using one table per term. Start and End Dates = Month and Year
2. List all courses, past, present, and future through degree completion for the degree funded.
3. Enter grades for courses already completed.
4. Recruitment Awardees: Note when each summer internship will be completed.
5. For each course, indicate the appropriate requirement code as follows:
R=Required/No Substitution Allowed
ED=Elective Necessary to Meet Degree Requirements
Term/Year:

P=Prerequisite
END = Elective NOT Necessary to Meet Degree Requirements

Start Date (YYYYMMDD):

End Date (YYYYMMDD):

NEEDS DD67

REQUIREMENT CODE

DEPT/COURSE NO.

Term/Year:

REQUIREMENT CODE

COURSE TITLE

Start Date (YYYYMMDD):

DEPT/COURSE NO.

CREDIT HOURS

GRADE

End Date (YYYYMMDD):

COURSE TITLE

CREDIT HOURS

GRADE

Awardee Initials:

DD FORM 3067-2, 20220701 DRAFT

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Term/Year:

Start Date (YYYYMMDD):

REQUIREMENT CODE

DEPT/COURSE NO.

Term/Year:

COURSE TITLE

Start Date (YYYYMMDD):

REQUIREMENT CODE

Term/Year:

End Date (YYYYMMDD):

DEPT/COURSE NO.

CREDIT HOURS

End Date (YYYYMMDD):

COURSE TITLE

CREDIT HOURS

NEEDS DD67

REQUIREMENT CODE

Start Date (YYYYMMDD):

DEPT/COURSE NO.

Term/Year:

REQUIREMENT CODE

GRADE

End Date (YYYYMMDD):

COURSE TITLE

Start Date (YYYYMMDD):

DEPT/COURSE NO.

GRADE

CREDIT HOURS

GRADE

End Date (YYYYMMDD):

COURSE TITLE

CREDIT HOURS

GRADE

Awardee Initials:

DD FORM 3067-2, 20220701 DRAFT

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Term/Year:

Start Date (YYYYMMDD):

REQUIREMENT CODE

DEPT/COURSE NO.

Term/Year:

COURSE TITLE

Start Date (YYYYMMDD):

REQUIREMENT CODE

Term/Year:

End Date (YYYYMMDD):

DEPT/COURSE NO.

CREDIT HOURS

End Date (YYYYMMDD):

COURSE TITLE

CREDIT HOURS

NEEDS DD67

REQUIREMENT CODE

Start Date (YYYYMMDD):

DEPT/COURSE NO.

Term/Year:

REQUIREMENT CODE

GRADE

End Date (YYYYMMDD):

COURSE TITLE

Start Date (YYYYMMDD):

DEPT/COURSE NO.

GRADE

CREDIT HOURS

GRADE

End Date (YYYYMMDD):

COURSE TITLE

CREDIT HOURS

GRADE

Awardee Initials:

DD FORM 3067-2, 20220701 DRAFT

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Term/Year:

Start Date (YYYYMMDD):

REQUIREMENT CODE

DEPT/COURSE NO.

Term/Year:

COURSE TITLE

Start Date (YYYYMMDD):

REQUIREMENT CODE

Term/Year:

End Date (YYYYMMDD):

DEPT/COURSE NO.

CREDIT HOURS

End Date (YYYYMMDD):

COURSE TITLE

CREDIT HOURS

NEEDS DD67

REQUIREMENT CODE

Start Date (YYYYMMDD):

DEPT/COURSE NO.

Term/Year:

REQUIREMENT CODE

GRADE

End Date (YYYYMMDD):

COURSE TITLE

Start Date (YYYYMMDD):

DEPT/COURSE NO.

GRADE

CREDIT HOURS

GRADE

End Date (YYYYMMDD):

COURSE TITLE

CREDIT HOURS

GRADE

Awardee Initials:

DD FORM 3067-2, 20220701 DRAFT

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Term/Year:

Start Date (YYYYMMDD):

REQUIREMENT CODE

DEPT/COURSE NO.

Term/Year:

COURSE TITLE

Start Date (YYYYMMDD):

REQUIREMENT CODE

Term/Year:

End Date (YYYYMMDD):

DEPT/COURSE NO.

CREDIT HOURS

End Date (YYYYMMDD):

COURSE TITLE

CREDIT HOURS

NEEDS DD67

REQUIREMENT CODE

Start Date (YYYYMMDD):

DEPT/COURSE NO.

Term/Year:

REQUIREMENT CODE

GRADE

End Date (YYYYMMDD):

COURSE TITLE

Start Date (YYYYMMDD):

DEPT/COURSE NO.

GRADE

CREDIT HOURS

GRADE

End Date (YYYYMMDD):

COURSE TITLE

CREDIT HOURS

GRADE

Awardee Initials:

DD FORM 3067-2, 20220701 DRAFT

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SECTION 4 – Scholarship Award Information
Answer Each Question

Notes

1. Does - the degree level that you are pursuing match your award information, per
your Service Agreement?

Yes

No

2. Does your field of study match your award information?

Yes

No

3. Does your degree completion date match your award information?

Yes

No

4. Did you verify your degree conferral date with your school?

Yes

No

5. Have you been admitted to, or are you enrolled in, the school listed on your award?

Yes

No

6. Did you verify your school’s academic calendar system (semester/quarter)?

Yes

No

7. Do you understand your requirement to submit official transcripts within 30 days of
the completion of each academic term?

Yes

No

SECTION 5 – Detailed Degree Information
Answer Each Question

Notes

1. Is your degree title a Technology degree (i.e., Electrical Engineering Technology or
Mechanical Engineering Technology)?

Yes

No

2. Is your degree title an Arts degree (i.e., BA or MA)?

Yes

No

3. Is your degree primarily an online or distance learning degree?

Yes

No

4. Are you completing a dissertation/thesis project?

Yes

No

5. Have you discussed aligning your dissertation/thesis with sponsoring facility?

Yes

No

NEEDS DD67

6. How many SMART summer internships are you attending?
7. How many years are you funded for your degree?

8. Are all of your planned SMART internships detailed above in Section 3 (Course
Listing) of this document?

Yes

9. How many remaining years do you need to complete your degree (including SMART
internships)?
10. Does your answer to number 9 match the years listed in number 7 and on your
approved Service Agreement? (If no, please contact your Scholar Coordinator to
discuss an award adjustment)

Yes

No

11. Did you confirm all transferred courses were accepted by your school and count
towards your degree?

Yes

No

12. Did you consider prerequisites, scheduling sequences, and course availability
when making your EWP?

Yes

No

13. Does your EWP reflect full-time enrollment for all terms, as required by SMART
Program policy?

Yes

No

Awardee Initials:

DD FORM 3067-2, 20220701 DRAFT

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File Typeapplication/pdf
File TitleDD Form 3067-2, "Science, Mathematics, and Research for Transformation (SMART) Scholarship Educational Work Plan"
File Modified2022-07-01
File Created2022-06-28

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