STUDENT INFORMATION
.gov or .mil Unclassified Email
Phone
Job Title
Years of Experience
Contractor Company
Military Branch
Other
ORGANIZATION INFORMATION
Government Area
Other
Work Location
(US)
Supervisors Name Email Phone
If Contractor
Government Sponsor
Email
Phone
COURSE SELECTION
Course Requested
Course Date 1
st
Choice 3
rd
Choice
*ICD 704 Personnel Security Course ONLY: check all that apply:
Adjudicator Investigator
F ir s t Name
How would you like your name to appear on your Course Certificate?
Grade/Rank
• A minimum of a Secret Clearance is required for attendance. (Interim Clearances are NOT accepted.)
• Clearance information will be validated in Sc
attered Castles.
• All Contractors must have Government Sponsor approval and justification.
• A .gov or a .mil email address is required to register.
• Documentation should be sent to NCSC-Training@dni.gov
This form contains For Official Use Only Privacy Act ( 5 USC Section 552a) or Sensitive Information intended only for NCSC Security Training Program use. Any misuse or unauthorized disclosure may result in both civil and criminal
penalties (18 USC Section 2510-2521). If you have received this form in error, please notify NCSC-Training@dni.gov, delete the electronic message and destroy any copies you may have made of the email and/or its attachments. Any
disclosure, copying, distribution, or use of the contents of the information received in error is strictly prohibited.
FEES: Training is provided at no cost. Student’s organization is responsible for travel, meals and lodging expenses.
APPROVALS
Upon acceptance of enrollment you will receive:
• Confirmation of enrollment
• Welcome packet
• Reminder email
Security Training Program
Course Request Form
YOU ARE NOT REGISTERED FOR THIS COURSE UNTIL YOU RECEIVE A CONFIRMATION OF ENROLLMENT FROM THE REGISTRAR.
ALL fields are required.
Federal Agency / Organization Supporting
2
nd
Choice
Work Location
(If Outside US)
