OMB No. 0704-0368
NATIONAL SECURITY EDUCATION PROGRAM (NSEP)
OMB approval expires
SERVICE AGREEMENT FOR SCHOLARSHIP AND FELLOWSHIP AWARDS
Nov 30, 2017
The public reporting burden for this collection of information, 0704-0368, 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 firstname.lastname@example.org. 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.
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 PURPOSES: To establish a service agreement for all individuals receiving NSEP scholarships or fellowships.
ROUTINE USE(S): Law Enforcement; Congressional Inquiries Disclosure; Department of Justice for Litigation; Disclosure of Information to the
National Archives and Records Administration; Data Breach Remediation Purposes; other routine uses may be listed in the applicable system of
records notice DHRA 09, National Security Education Program – Information Technology and is located at:
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.
b. SOCIAL SECURITY NUMBER
a. FULL NAME (Last, First, Middle Initial)
c. TYPE OF AWARD (X one)
d. MAILING ADDRESS
(1) STREET AND APARTMENT/SUITE NUMBER
(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.
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
(1) BEGINNING (YYYYMMDD)
(2) ENDING (YYYYMMDD)
(3) TOTAL NUMBER OF MONTHS
5. SERVICE OBLIGATION
Based on the currently calculated length of time covered by my award, I understand that my term of service will be
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.).
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)
9. FOR NSEP USE ONLY
YEAR OF AWARD
10. ADMINISTRATIVE AGENT
a. NAME (Last, First, Middle Initial)
c. DATE SIGNED (YYYYMMDD)
11. DIRECTOR, NATIONAL SECURITY EDUCATION PROGRAM
b. DATE SIGNED (YYYYMMDD)
PREVIOUS EDITION IS OBSOLETE.
DD FORM 2752, NOV 2014
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