Cybersecurity Awareness Training Certificate
I certify that I have completed the Cybersecurity Awareness Training course. I have read and acknowledged the
Department of Health and Human Services (HHS) Rules of Behavior. I understand the requirements for access to
departmental information technology (IT) systems and my responsibilities as a system user.
Please complete all of the information below:
STAFFDIV/Office:
Last Name:
First Name:
E-Mail:
Manager's Name:
EOD/Date you started work at HHS:
Date Cybersecurity Awareness Training completed:
Date Role-Based Training completed (if applicable):
Contractors complete this section
Name of Company:
Contract Number (prime only):
Contracting Officer's Technical
Representative (COTR) Name:
Signature Date Day Phone
Print this certificate, sign and date it.
• Employees: Send the completed certificate to the FISMA POC for your STAFFDIV.
• Contractors: Send the completed certificate to your COTR.
This form cannot be processed if your name or completion dates are omitted or illegible, or if your signature is
omitted.
If you need assistance please contact the Office of Information Security (OIS) Training Team at
OIS_Training@hhs.gov.
June 2016
