Form DD 3067-13 DD 3067-13 Science, Mathematics, and Research for Transformation (S

Science, Mathematics, and Research for Transformation (SMART) Scholarship
Site Visit Report for Recruitment Awardees

OMB NO. 0704-0466
OMB approval expires
YYYYMMDD

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 site visit feedback from SMART Recruitment Awardees.
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. 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 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 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.
INSTRUCTION: All SMART Recruitment Awardees who completed a site visit at their Sponsoring Facility (SF) must complete a SMART Scholarship Site Visit
Report for Recruitment Awardees no later than five days of the conclusion of the site visit.

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

Cohort Year:

Phone:

Email:

Sponsoring Component:

Supervisor Name:

NEEDS DD67
Sponsoring Facility (SF):

Supervisor Email:

Site Visit Start Date (YYYYMMDD):

Site Visit End Date (YYYYMMDD):

SECTION 2 – Site Visit Structure
Please type answers in paragraph form using a maximum of 1200 characters/approximately 200 words.
Did your site visit date(s) change since you submitted your site visit request?

Yes

No

If yes, please provide the new dates and reason for the change:

In what ways was your SF prepared for your site visit?

What did you accomplish during the site visit?

Summarize who you were able to meet with at your SF. Was a communication plan established?

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SECTION 3 – Ability to Apply Knowledge and Skills
In what ways can your skills or knowledge from your field of study be utilized at your SF?

If you are a graduate student, how will you be able to align your research with your SF’s mission? (Undergraduate students leave blank)

SECTION 4 – Site Visit Funding and Overall Experience
Were you provided with sufficient funding to support your ability to attend the site visit?

Did your SF provide you with a clear understanding of the SF’s mission?

NEEDS DD67

Do you believe you are a good fit with your SF and its mission?

During the site visit, were you provided with information regarding your expected, post-graduation civilian position with the SF (e.g., job title, grade,
salary, benefits, career path, etc.)?
Yes

No

If yes, please summarize the discussion and expectations set between you and the SF.

SECTION 5 – Reaffirm Award (initial next to acknowledgement and selected decision)
I acknowledge that any discussion or details shared by my SF during my site visit regarding my expected post-graduation civilian employment
(e.g., job title, grade, salary, benefits, career path) are for informational purposes only. After my SMART Program-funded degree has been awarded to me, I
understand that my SF is only committed to offering me full-time employment and that the salary for this employment will be commensurate with Office of
Personnel Management, Command, and/or SF-specific requirements, policies, and guidelines in effect at the time that an offer is made.
After reviewing all aspects of my SF and site visit, I have determined that I am a good fit with the SF, and I am reaffirming my decision to accept
the SMART award.
After reviewing all aspects of my SF and site visit, I have determined I am not a good fit with the SF, and I have chosen to opt out of the SMART
award.
If opting out of the SMART award, please provide any comments regarding your decision in the space below.

SECTION 6 – Signature
a. NAME (Last, First, Middle Initial)

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b. SIGNATURE

c. DATE SIGNED (YYYYMMDD)

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