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OMB No. 0704-0368
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NATIONAL SECURITY EDUCATION PROGRAM (NSEP)
SERVICE AGREEMENT FOR SCHOLARSHIP AND FELLOWSHIP AWARDS
The public reporting burden for this collection of information 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 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 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.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO: Defense Language and National Security
Education Office (DLNSEO), 4800 Mark Center Drive, Suite 08F09-02, Alexandria, VA 22350.
PRIVACY ACT STATEMENT
AUTHORITY: 50 U.S.C. 1901, David L. Boren National Security Education Act of 1991; DoD Instruction (DoDI) 1025.02, National Security Education
Program (NSEP) and NSEP Service Agreement; and E.O. 9397 (SSN), as amended.
PRINCIPAL PURPOSE(S): To establish a service agreement for all individuals receiving NSEP scholarships or fellowships.
ROUTINE USE(S): To The Institute for International Education for monitoring the performance of The Language Flagship and Project GO institutional programs and student
performance in these programs, as well as review and validation of NSEP awardee information and repayments; other routine uses are listed in the applicable system of records notice
DHRA 09, National Security Education Program – Information Technology and is located at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/
Article/570561/dhra-09/
DISCLOSURE: Voluntary; however, DoD may revoke its proffer of your Scholarship or Fellowship if you do not furnish the information.
The information contained in this form will be entered by the Administrative Agent.
1. RECIPIENT
a. FULL NAME (Last, First, Middle Initial)
b. SOCIAL SECURITY NUMBER c. TYPE OF AWARD (X one)
SCHOLARSHIP
FELLOWSHIP
d. MAILING ADDRESS
(1) STREET AND APARTMENT/SUITE NUMBER
(2) CITY
(3) STATE
(4) ZIP CODE
2. SATISFACTORY ACADEMIC PROGRESS AND SERVICE OBLIGATION ACKNOWLEDGEMENT
I agree that by accepting this National Security Education Program award, I will maintain the academic standards of my home and host institution(s) for the
duration of my study program. In accepting this award, I also agree that upon completion of my study program I will seek employment in the Departments of
Defense, Homeland Security, State, or the Intelligence Community, or, if no suitable position is available, anywhere in the Federal Government in a position with
national security responsibilities. If I am unsuccessful in finding a Federal position after making a good faith effort to do so, I agree to seek employment in the
field of education in a position related to the study supported by my scholarship/fellowship. I understand that I must fulfill the service requirement in one of the
three options outlined above.
DRAFT
3. TERMINATION OF ASSISTANCE
I understand that this award may be terminated if I fail to maintain the academic standards of my home and host institutions during my study program. If this
occurs I understand that I must reimburse the U.S. Government for the amount tendered to me for the award plus interest on that amount from the date of the
award at the prescribed rate under Section 3717 of 31 U.S.C.
4. AMOUNT AND DURATION OF AWARD
a. AMOUNT
b. DURATION
(1) BEGINNING (YYYYMMDD)
(3) TOTAL NUMBER OF MONTHS
(2) ENDING (YYYYMMDD)
5. SERVICE OBLIGATION
Based on the currently calculated length of time covered by my award, I understand that my term of service will be
months.
I understand that I am required to submit to the designated Administrative Agent the DD Form 2753, "Service Agreement Report," on an annual basis until all my
obligations are satisfied. I understand that my work in fulfillment of the service agreement must be wholly completed within five years of my first date of service
unless an approved deferral or extension has been granted. I understand that I must reimburse the U.S. Government for the amount of the award plus interest if I
do not fulfill my work obligations incurred under this program.
6. CHANGES TO AWARD PROGRAM
I agree to obtain approval from the Administrative Agent for any academic or administrative change to the approved program for which this award was made
(i.e., course and schedule changes, withdrawals, incompletions, unanticipated or increased costs, etc.).
7. DISCLAIMER
I understand that this Agreement does not in any way obligate the Federal Government, the Administrative Agent, or the educational institutions with which I
am associated to provide me employment, or continue my employment.
8. CERTIFICATION BY RECIPIENT
In accepting my award, I certify that I have read and understand the Conditions, Terms, and Requirements of the Service Agreement and that I will comply
with them. This Agreement is an important condition of your award. Please read it carefully before signing.
b. DATE SIGNED (YYYYMMDD)
a. SIGNATURE
9. FOR NSEP USE ONLY
YEAR OF AWARD
10. ADMINISTRATIVE AGENT
a. NAME (Last, First, Middle Initial)
b. SIGNATURE
c. DATE SIGNED (YYYYMMDD)
11. DIRECTOR, NATIONAL SECURITY EDUCATION PROGRAM
b. DATE SIGNED (YYYYMMDD)
a. SIGNATURE
DD FORM 2752, 20210924 DRAFT
PREVIOUS EDITION IS OBSOLETE.
CUI (when filled in)
Controlled by: DLNSEO
Page
CUI Category: PRIV
Distribution/Dissemination Control: FEDCON
POC: [email protected]
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File Type | application/pdf |
File Title | DD Form 2752, "National Security Education Program (NSEP) Service Agreement For Scholarship And Fellowship Awards" |
Author | DoD Component |
File Modified | 2021-09-24 |
File Created | 2021-06-21 |