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I understand that the purpose of completing the Personnel Security Prescreen Questionnaire is relative
to obtaining a security clearance or access to national security information, and that my answers and
statements on these forms are privileged information between the United States government, myself
and Texas A&M University System Research Security Office (RSO) personnel.
By submitting this form, I hereby voluntarily waive the privilege above and authorize designated RSO
personnel to review any portion necessary of the Personnel Security Prescreen Questionnaire for the
purpose of prescreening a security clearance or the submittal of a security clearance. I understand that
the Personnel Security Prescreen Questionnaire will only be used for official use only to help
determine my eligibility for, or verification of, a security clearance and/or access to national security
information. All personal information provided will be protected IAW the Privacy Act of 1974.
I agree to hold The Texas A&M University System, its agents, directors, employees, subsidiaries,
affiliates, and/or representatives, harmless from any claims, damages, losses, liabilities, costs and
expenses (including attorney and legal fees), or any other charge or complaint filed, arising from the
disclosing, retrieving, reporting, and use of the information referred to above during the preliminary
eligibility determination process for obtaining a security clearance.
I Accept I Decline
I certify that the entries made by me on the Personnel Security Prescreen Questionnaire are
voluntary, accurate, and complete to the best of my knowledge and belief and are made in good
faith. I also certify that the answers provided on this form will be consistent with information
that will be provided on any additional forms required by TAMUS/RSO to include, but not
limited to, the Standard Form 86 (SF-86) Personnel Security Investigation Questionnaire or
(eQIP) Electronic Questionnaires for Investigations Processing. I also acknowledge that I have
a right to decline to complete this Personnel Security Prescreen Questionnaire information. If I
choose to decline, then I understand this could significantly impact my ability to be considered
for a U.S. Government internship position.
Electronic or Hand Written Signature
PRIVACY ACT OF 1974 APPLIES
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