Dd Form 2935 - National Language Service Corps (Nlsc) Pilot Language Data Sheet - 2009

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FOR NLSC USE ONLY

NATIONAL LANGUAGE SERVICE CORPS (NLSC) PILOT

OMB No. 0704-0449

CONTROL NUMBER

OMB approval expires

LANGUAGE DATA SHEET

Apr 30, 2012

PLEASE DO NOT RETURN YOUR FORM TO THE ORGANIZATION LISTED IN THE PARAGRAPH BELOW. RETURN COMPLETED FORM TO:

NATIONAL LANGUAGE SERVICE CORPS, P.O. BOX 12221, ARLINGTON, VA 22209-2221

The public reporting burden for this collection of information is estimated to average 20 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, Executive Services Directorate, Information Management Division, 1155 Defense Pentagon,

Washington, DC 20301-1155 (0704-0449). 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.

PRIVACY ACT STATEMENT

AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. 131, Office of the Secretary of Defense; DoD Directive 5124.2, Under Secretary of Defense for Personnel and

Readiness; 50 U.S.C. 403-1b, War and National Defense; Public Law 109-364, Sec. 944, Administration of Pilot Project on Civilian Linguist Reserve Corps; and Public Law

108-487, Sec. 613, Pilot Project on Civilian Linguist Reserve Corps. The OSD System of Records Notice name and number for this collection is National Language Service Corps

Pilot, DHRA 07.

PRINCIPAL PURPOSE(S): To allow U.S. citizens aged 18 years and older with language and special skills to self-identify language-related data for NLSC Pilot Charter

Membership. Those selected for activation and deployment will be officially tested to validate NLSC Self Assessment skills. The information collected will be used to identify and

contact NLSC Charter Members and prospective Charter Members in times of need. The collection will allow preliminary background checks prior to any final appointment in the

NLSC of only those individuals the NLSC expects to employ temporarily during the Pilot program. Background checks are not expected for the remaining Charter Members.

ROUTINE USE(S): To Federal Government agencies requesting language support to facilitate U.S. efforts on the war on terrorism or in furtherance of national security objectives.

The DoD "Blanket Routine Uses" set forth at the beginning of OSD's compilation of systems of records notices apply to this system.

DISCLOSURE: Voluntary. However, failure to provide information may result in non-enrollment in the NLSC Pilot, and refusal to grant access to Charter Member areas of the

NLSC Pilot Internet portal.

SECTION I - BASIC BACKGROUND INFORMATION

1. DID YOU GROW UP ABROAD?

2. ARE YOU A U.S. HIGH SCHOOL GRADUATE?

(X one)

YES

(X one)

YES

3. LANGUAGE FOR WHICH YOU

4. WHAT IS YOUR NATIVE

5. WHICH LANGUAGE DO YOU

4.a. IF ENGLISH IS NOT YOUR NATIVE

ARE APPLYING TO THE NLSC

LANGUAGE?

USE THE MOST OFTEN?

LANGUAGE, AT WHAT AGE DID YOU BEGIN

LEARNING ENGLISH?

SECTION II - BACKGROUND FOR (Foreign language for which you are applying to NLSC)

6. WHERE DO YOU USE THIS LANGUAGE?

HOME

(X all that apply)

WORK

RESEARCH

OTHER

7. NUMBER OF YEARS USING THIS LANGUAGE

8. NUMBER OF YEARS OF FORMAL TRAINING FOR THIS LANGUAGE

a. YEARS

b. MONTHS

a. YEARS

b. MONTHS

9. HOW OFTEN DO YOU USE THIS LANGUAGE?

(X one)

ALWAYS

SOMETIMES

RARELY

SECTION III -WORK HISTORY IN THE LANGUAGE FOR WHICH YOU ARE APPLYING TO NLSC

10. HAVE YOU EVER WORKED AS:

(X one)

FROM:

TO:

(X all that apply)

PAID

UNPAID

a. INTERPRETER

b. TRANSLATOR

c. LANGUAGE TEACHER

Questions 11 - 13 focus on previous employment requiring professional use of your language skills other than those identified in Item 10. If needed, please

attach additional sheets.

13. DATES

(YYYYMMDD)

11. JOB TITLE

12. JOB DESCRIPTION

FROM

SECTION IV - LANGUAGE TESTING (Other than English)

14. HAVE YOU TAKEN ANY PROFICIENCY TEST OR CERTIFICATION TEST FOR THIS LANGUAGE?

(Defense Language Proficiency Test (DLPT), ACTFL Oral

Proficiency Interview, Foreign Service Oral Proficiency Interview, American Translators Association Certification, Federal Judicial Interpreter Certification, other)

YES

NO (If No, please skip to Section V)

a. NAME OF TEST

b. TEST DATE (YYYYMMDD) c. TEST SCORE

SECTION V - LANGUAGE LEARNING HISTORY (Other than English)

15. HOW DID YOU LEARN THIS LANGUAGE?

(X all that apply)

a. AT HOME AS A CHILD

b. COLLEGE STUDY IN THE U.S.

(1) NAME OF INSTITUTION

(2) FIELD OF STUDY

(3) DEGREE RECEIVED