CISA Out-Processing Information Form

CISA End of Year Information Form

(AY 23)

Survey Info & Email Invitation: Please take a few minutes to complete the CISA End of Year Information Form. Your responses are required for graduation planning, end of year information data collection, and alumni communications. Please submit your response by Monday, March, 27^th, COB. 

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 (DNDU01, September 21, 2010, 75 FR 57458). This 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.

OMB CONTROL NUMBER: 0704-0598

OMB EXPIRATION DATE: 12/31/2023

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information, 0704-0598, 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.

Select your CISA academic program:

• Regional Defense Fellowship Program (RDFP) (1)

• Joint Special Operations Master of Arts (JSOMA) (2)

Diploma & Commencement Program Information

Type your name as you would like it listed on your diploma. Please note that titles/ranks will not show on the diploma. You may include full middle name, Jr., etc, but NO nicknames. The following are permissible: John S. Doe or John Samuel Doe or John Doe, Jr. Nicknames such as John "Buzzy" Doe are not allowed.

________________________________________________________________

Please write out the phonetics/pronunciation of your name. 
For example, Name: Karim Muhammad; Phonetics: Ka-REEM  MUH-HAM-UHD

________________________________________________________________

What is your rank/title? (Examples: Mr., Ms., COL, Col, LTC, etc)

________________________________________________________________

Type your name as you would like it listed in the commencement program in the following format: "LAST NAME, First Name, Rank/Title" (i.e. DOE, John, COL) 
You may include titles/ranks for the program. You may include full middle name, Jr., etc, but NO nicknames. 

________________________________________________________________

What is your branch of service/agency?

• Army (4)

• Navy (5)

• Air Force (6)

• Marine Corps (7)

• Coast Guard (8)

• Police (9)

• DHS (10)

• State (11)

• DIA (12)

• DoT (13)

• DoD (14)

• NCTC (15)

• DoE (16)

• Other (17) __________________________________________________

What is your country affiliation? U.S. Students can write in "US" 

________________________________________________________________

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What is your official thesis title?

________________________________________________________________

Please list the name of your thesis advisor.

________________________________________________________________

Alumni Office Information 

What is your preferred first name?

________________________________________________________________

What is your preferred non-NDU email address?

________________________________________________________________

What is your preferred telephone number?

________________________________________________________________

What was your position pre-CISA?

________________________________________________________________

What is/will be your position post-CISA?

________________________________________________________________

Do you expect to be promoted after your graduation from CISA?

• Yes (1)

• Maybe (2)

• No (3)

How can CISA support your professional development?

________________________________________________________________

Alumni communications: Would you like to be added to the Washington D.C. or Fayetteville, NC CISA Events distribution group?

• Washington D.C. (1)

• Fayetteville, NC (2)

Would you like to receive a NDU Alumni email account?

• Yes (1)

• No (2)

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