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  1. Header and Part I: Completed by user

    1.  

      image-20240110-153937.png

    2. All blocks must be complete.

    3. LOCATION (Physical Location of System) MUST be HCS Kansa Kansas City no matter where you are located.

    4. Block 1: Your name.

    5. Block 2: Your government agency.

    6. Block 3: Your units name.

    7. Block 4: A number you can be reached at.

    8. block 5: The email address issued to you by a government agency.

    9. Block 6: Your Job Title and Rank

    10. Block 7: is your units mailing address.

    11. Blocks 8 and 9 are specific to you and must be checked

    12. The date in block 10 must match the date on the cyber awareness certificate you provide.

      1. This is the current list of accepted certificates.

        1. Option 1 - Cyber Awareness & PII Combined Certification

          1. CYBERM0000 USMC Cyber Awareness Training (Marine Net) (active and reserve military only)

          2. CYBERC Civilian Cyber Awareness Training (Marine Net) (contract and civilian employees)

          3. CYBERINTEL Intelligence Community Cyber Awareness Training Curriculum

          4. ANNUALTRFYAnnual Training Curriculum Fiscal Year (MarineNet)

        2. Option 2 - Cyber Awareness + PII individual courses

          1. DODCAC1000 DOD Cyber Awareness Challenge + DONPII010A Department of the Navy Annual Privacy Training (Marine Net)

          2. DOD-IAA-V17.0 Cyber Awareness Challenge V5 + DON-PRIV-2.0 Department of the Navy Annual Privacy Training (TWMS)

          3. Cyber Awareness Challenge + Identifying and Safeguarding Personally Identifiable Information (PII) (DISA)

          4. INTELCAC Cyber Awareness Challenge (Intel Community) + DONPII010A Department of the Navy Annual Privacy Training (Marine Net)

    13. Your digital signature is required in block 11. Ensure the date in block 12 is the same date you digitally sign block 11.

  2. Part II: Completed by supervisor

    1.  

      image-20240110-154527.png

    2. Block 13- Justification must match the system listed in the system name block.

      1. A concise statement for why access is required along with the following information:

        1. Site: Your location

        2. Application role requested

        3. Environment is NIPR Production

        4. Any additional detail to specify access requirements

          1. Example for STRATIS SAAR

            1. Site: BIC

              Role: ADM

              Permission Group: Interface User

              Risk: Annually Validation

          2. Example for CLC2S

            1. Site: (I MEF, II MEF, III MEF, MFR, etc)

              Application role requested: (Clerk, Principal Staff, Rations Coordinator, Corpsman, or Unit Supervisor)

              Environment: NIPR Production

              Risk: MARADMIN 229/22

          3. Example for TCPT

            1. Site: (I MEF, II MEF, III MEF, MFR, etc)

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