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Privacy Act-Agency Disclosure
| PRIVACY ACT STATEMENT: |
| Authority for collecting information requested on the DoW Cyber Service Academy Application is contained in 5 U.S.C. Section 4101-4121, 10 U.S.C. §2200, Executive Order 13111, Executive Order 11348, as amended, and DoW Directive 8500.2. DoW’s Blanket Routine Uses (found at Appendix C of 32 CFR Part 310) and the specific uses found in GNSA27 apply to this information. The requested information will be used to determine eligibility for the DoW Cyber Service Academy. Disclosure of the requested information is voluntary. However, failure to provide the requested information will prevent the processing of your application and the determination of your eligibility for the DoW Cyber Service Academy |
| AGENCY DISCLOSURE NOTICE: |
| AGENCY DISCLOSURE NOTICE |
The public reporting burden for this collection of information, 0704-0486, is estimated to average 44 hours 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 War, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. 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.
DoW CSA Excel Budget Sheet OMB Control Number: 0704-0486 OMB Expiration Date:
Cover Sheet
| ENTER INSTITUTION NAME |
| University Information |
| Address: |
| Address: |
| City: |
| State: |
| Zip Code: |
| Approximate Date Tuition Increase Decisions are Made: |
| Principal Investigator / Project Director / Technical POC |
| Name |
| Email Address |
| Co-Principal Investigator / Project Director / Technical POC / Admin Lead |
| Name |
| Email Address |
| Name |
| Email Address |
| University Office of Business Negotiations / Financial / Grant POC |
| Pre-Grant Negotiations |
| Name |
| Email Address |
| Post-Grant negotiations |
| Name |
| Email Address |
Recruitment
| DoD CSA Recruitment Scholarships (New and Returning Scholars) | | | |
| ENTER INSTITUTION NAME | FILL IN ONLY THE YELLOW SHADDED BLOCKS | |
| | LAPTOPS* | Each institution handles the issuance of laptops differently. In order to accomdate those differences, the laptop allowance is identified in two locations. Pick the one location that works best for your institution. |
| NEW | | |
| RETURNING | | |
| A | Student Costs | | | | | | | | | | | | | | | | | | |
| DIRECT COSTS | New DoD CSA Applicants | | | | | | | | | | | | | | | | | |
| | Community College | | | | | | Undergraduate | | | | | | Graduate | | | | | |
| | In-State | | Online | | Out-of-State | | In-State | | Online | | Out-of-State | | In-State | | Online | | Out-of-State | |
| Number of Students | 0 | | 0 | | 0 | | 0 | | 0 | | 0 | | 0 | | 0 | | 0 | |
| Name of Students (Last Only) | | | | | | | | | | | | | | | | | | |
| Tuition | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Additional Credits | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Fees / Health Insurance | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Stipend | $ 25,000.00 | $ - 0 | $ 25,000.00 | $ - 0 | $ 25,000.00 | $ - 0 | $ 29,000.00 | $ - 0 | $ 29,000.00 | $ - 0 | $ 29,000.00 | $ - 0 | $ 34,000.00 | $ - 0 | $ 34,000.00 | $ - 0 | $ 34,000.00 | $ - 0 |
| Laptop* | $ 1,650.00 | $ - 0 | $ 1,650.00 | $ - 0 | $ 1,650.00 | $ - 0 | $ 1,650.00 | $ - 0 | $ 1,650.00 | $ - 0 | $ 1,650.00 | $ - 0 | $ 1,650.00 | $ - 0 | $ 1,650.00 | $ - 0 | $ 1,650.00 | $ - 0 |
| Book/Supplies/Certifications* | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 |
| Total | $ 27,650.00 | $ - 0 | $ 27,650.00 | $ - 0 | $ 27,650.00 | $ - 0 | $ 31,650.00 | $ - 0 | $ 31,650.00 | $ - 0 | $ 31,650.00 | $ - 0 | $ 36,650.00 | $ - 0 | $ 36,650.00 | $ - 0 | $ 36,650.00 | $ - 0 |
| DIRECT COSTS | Returning DoD Scholars | | | | | | | | | | | |
| Undergraduate | | | | | | Graduate | | | | | |
| In-State | | Online | | Out-of-State | | In-State | | Online | | Out-of-State | |
| Number of Students | 0 | | 0 | | 0 | | 0 | | 0 | | 0 | |
| Name of Students (Last Only) | | | | | | | | | | | | |
| Tuition | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Additional Credits | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Fees / Health Insurance | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Stipend | $ 29,000.00 | $ - 0 | $ 29,000.00 | $ - 0 | $ 29,000.00 | $ - 0 | $ 34,000.00 | $ - 0 | $ 34,000.00 | $ - 0 | $ 34,000.00 | $ - 0 |
| Book/Supplies | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 | $ 1,000.00 | $ - 0 |
| Total | $ 30,000.00 | $ - 0 | $ 30,000.00 | $ - 0 | $ 30,000.00 | $ - 0 | $ 35,000.00 | $ - 0 | $ 35,000.00 | $ - 0 | $ 35,000.00 | $ - 0 |
| B | Faculty and Staff | | | | | Fringe Benefits | | | | |
| | Name | # Months | Rate | Total | | | $$ | Rate | Total |
| PI | | 0 | $ - 0 | $ - 0 | PI | 0 | $ - 0 | 0.00% | $ - 0 |
| Faculty 2 | | 0 | $ - 0 | $ - 0 | Faculty 2 | 0 | $ - 0 | 0.00% | $ - 0 |
| Admin 1 | | 0 | $ - 0 | $ - 0 | Admin 1 | 0 | $ - 0 | 0.00% | $ - 0 |
| Admin 2 | | 0 | $ - 0 | $ - 0 | Admin 2 | 0 | $ - 0 | 0.00% | $ - 0 |
| Community College Partner | | 0 | $ - 0 | $ - 0 | Community College Partner | 0 | $ - 0 | 0.00% | $ - 0 |
| Community College Partner | | 0 | $ - 0 | $ - 0 | Community College Partner | 0 | $ - 0 | 0.00% | $ - 0 |
| Other Staff | | 0 | $ - 0 | $ - 0 | Other Staff | 0 | $ - 0 | 0.00% | $ - 0 |
| Total | | | | $ - 0 | Total | | | | $ - 0 |
| C | Other* | | | | |
| Student Laptop* | 0 | $ 1,650.00 | $ - 0 | |
| Faculty Travel to CSA event | 1 | $ 2,000.00 | $ 2,000.00 | If partnering with a Community College CAE, you may add an additional trip for the Community College PI |
| Student Travel | 0 | $ 2,000.00 | $ - 0 | |
| Scholar Security Cert Fee (DoDI 8140) | 0 | $ - | $ - 0 | |
| Total | | | $ 2,000.00 | |
| Total Direct Costs | | | | |
| A+B+C | | | $ 2,000.00 | |
| INDIRECT COSTS | | | | |
| D | F&A | | | | |
| | | Rate | Total | |
| Percent Rate | $ 2,000.00 | 0% | $ - 0 | It is the CAE's responsbility to validate F&A rates are currently being charged on the correct items. |
TOTAL
C+D $ 2,000.00
PLEASE DOUBLE CHECK ALL CALCULATIONS!!!
&D DoD IASP Attachment D &A
Recruitment NEW Student Ranking Recruitment: NEW Student Endorsement and Ranking
ENTER INSTITUTION NAME
| NEW DoD CSA APPLICANTS - EXAMPLE | | | | | | | | | | |
| Rank Order | Student Name | | | | | | | | | |
| (LAST NAME, First Name) | Degree Name | Degree Level | Anticipated Graduation Date | Residence Status | Degree Delivery | Campus | Recommendation | Recommendation Statement | Required Summer Classes | DCWF Work Role | |
| EXAMPLE | Smith, Jane Q. | Computer Science and Information Systems | Bachelors | 2028 | In-State | In-Person | Main Campus Only | Highly-Recommended | Jane is an amazing student who is the captain of our Cyber Club. She has competed in 10 cyber competitions, with her team placing in the top 10 at 3 of the events. She is also a graduate of a GenCyber camp. Jane has obtain several security certifications and is active in her local WiCyS chapter. | No |
| EXAMPLE | Doe, John J. | Cybersecurity and Information security | Masters | 2027 | Out-of-State | In-Person | Satelllite Campus | Highly-Recommended | John leads the local B-Sides group and has hosted many on-campus cyber awarenes events. John has performed several internships with local cybersecurity companies building upon his expierence in the Army Reserves. He has obtain several security certifications and placed first in a national cyber capture-the-flag competition. | Yes |
| NEW DoD CSA APPLICANTS - 2026 COHORT | | | | | | | | |
| Rank Order | Student Name | | | | | | | |
| (LAST NAME, First Name) | Degree Name | Degree Level | Anticipated Graduation Date | Residence Status | Degree Delivery | Campus | Recommendation | Recommendation Statement | Required Summer Classes |
| 1 | | | | | | | | |
| 2 | | | | | | | | |
| 3 | | | | | | | | |
| 4 | | | | | | | | |
| 5 | | | | | | | | |
| 6 | | | | | | | | |
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| 8 | | | | | | | | |
| 9 | | | | | | | | |
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| 23 | | | | | | | | |
| 24 | | | | | | | | |
| 25 | | | | | | | | |
ADD MORE ROWS IF NEEDED
| Associates | 2027 | In-State | Online | Highly-Recommended | Yes |
| Bachelors | 2028 | Out-of-State | In-Person | Recommended | No |
| Bachelors/Masters | 2029 | | Hybrid | Not-Recommended | |
| Masters | 2030 | | | | |
| PhD | 2031 | | | | |
| Doctorate | 2032 | | | | |
Recruitment RETURNING Scholars Recruitment: Returning Scholar ReCap
| ENTER INSTITUTION NAME | | | | | | | | | |
| RETURNING Scholars - EXAMPLE | | | | | | | | | |
| | Student Name | | | | | | | | |
| (LAST NAME, First Name) | Degree Name | Degree Level | Anticipated Graduation Date | Funding Length | Residence Status | Degree Delivery | Campus | Required Summer Classes | | |
| EXAMPLE | Smith, Jane Q. | Computer Science and Information Systems | Bachelors | 2027 | Half-Year | In-State | In-Person | Main Campus Only | No |
| EXAMPLE | Doe, John J. | Cybersecurity and Information security | Masters | 2029 | Full-Year | Out-of-State | In-Person | Satelllite Campus | Yes |
| NEW DoD CSA APPLICANTS - 2026 COHORT | | | | | | | |
| | Student Name | | | | | | |
| (LAST NAME, First Name) | Degree Name | Degree Level | Anticipated Graduation Date | Funding Length | Residence Status | Degree Delivery | Campus | Required Summer Classes |
| 1 | | | | | | | |
| 2 | | | | | | | |
| 3 | | | | | | | |
| 4 | | | | | | | |
| 5 | | | | | | | |
| 6 | | | | | | | |
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| 8 | | | | | | | |
| 9 | | | | | | | |
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| 17 | | | | | | | |
| 18 | | | | | | | |
| 19 | | | | | | | |
| 20 | | | | | | | |
| 21 | | | | | | | |
| 22 | | | | | | | |
| 23 | | | | | | | |
| 24 | | | | | | | |
| 25 | | | | | | | |
ADD MORE ROWS IF NEEDED
| Associates | 2027 | Full-Year | In-State | Online | Yes |
| Bachelors | 2028 | Half-Year | Out-of-State | In-Person | No |
| Bachelors/Masters | 2029 | | | Hybrid | |
| Masters | 2030 | | | | |
| PhD | 2031 | | | | |
| 2032 | | | | |
Retention DoW Civs Military
| Retention Scholarships | |
| ENTER INSTITUTION NAME |
| DIRECT COSTS | | | | | | |
| Students | | | | | | |
| FILL IN ONLY THE YELLOW SHADED BLOCKS | | | | | | |
| # of students | Community College | 0 | Masters | 0 | PhD | 0 |
| Tuition | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Fees | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Books | $ 750.00 | $ - 0 | $ 750.00 | $ - 0 | $ 750.00 | $ - 0 |
| A | Total | $ 750.00 | $ - 0 | $ 750.00 | $ - 0 | $ 750.00 | $ - 0 |
| Faculty and Staff | | | | | | |
| Position: | Name | # Months | Rate | Total | | |
| PI | | 0 | $ - 0 | $ - | | |
| Faculty 2 | | 0 | $ - 0 | $ - | | |
| Admin 1 | | 0 | $ - 0 | $ - | | |
| Admin 2 | | 0 | $ - 0 | $ - | | |
| B | Total | | | | $ - 0 | | |
| Fringe Benefits | | | | |
| | | $$ | Rate | Total |
| PI | 0 | 0.00 | 0.00% | $ - |
| Faculty 2 | 0 | 0.00 | 0.00% | $ - |
| Admin 1 | 0 | 0.00 | 0.00% | $ - |
| Admin 2 | 0 | 0.00 | 0.00% | $ - |
| C | Total | | 0.00 | | $ - |
| Other - note, student related items added above | | | |
| | # trips | amount | Total |
| Travel Faculty | 1 | $ 1,750.00 | $ 1,750.00 |
| D | Total | | | $ 1,750.00 |
| Total Direct Costs | | | |
| E | A+B+C+D | | | $ 1,750.00 |
| INDIRECT COSTS | | | | |
| F&A | | | | |
| | Tot. Dir. Costs | | Rate | Total |
| F | Percent Rate | SEE NOTE | $ 1,750.00 | 0% | $ - 0 |
| G | GRAND TOTAL OF ANNEX I STUDENTS | $ 1,750.00 |
| *value will change once a percent factor is applied. | |
| F&A NOTE: | F&A Percent calculation is on what your university is authorized to charge on. In this form it is based upon "C", but this may not be applicable to all of the universities. | | | |
| CURRENT STUDENT NAMES: | | YEAR | ANTICIPATED GRAD DATE | ORIGINAL AWARD DATE |
Retention Degree Identification
ENTER INSTITUTION NAME
| Partnership Program ONLY | | | | | | | | | | |
| DoW Identified Training Program | Number of Credits Award Through Partnership | Degree Level | Degree /Certificate Name | Number of Credits | Degree Delivery | Estimated Time to Complete | Application Deadline | Any Additionall Degree Requirements (GRE, GMAT, etc) | POC For Identified Degree Program | |
| | Associates | A.A.S Information Systems and Cybersecurity | 60 | Online | 2 years | n/a | n/a | Name, email address, phone number | Examples |
| Joint Cyber Analysis Course | 15 | Bachelors | BS Cybersecurity | 120 | Hybrid | 4 years | Sep-26 | n/a | Name, email address, phone number | |
| Joint Cyber Analysis Course | 9 | Masters | MS Information Systems | 40 | Online | 18 months | Sep-26 | Undergraduate degree | Name, email address, phone number | |
| | Gradutate Certificate | Cybersecurity Technology Graduate Certificate | 15 | Online | 1 year | Fall 2026 | n/a | Name, email address, phone number | |
| Associates | Online |
| Bachelors | In-Person |
| Bachelors/Masters | Hybrid |
| Masters | |
| PhD | |
| Gradutate Certificate | |
Capacity Building
| CAPACITY BUILDING | |
| ENTER INSTITUTION NAME |
DIRECT COSTS
| Project Name | Outreach to Academia: Faculty Development | | | | Project Name | Outreach to Academia: Curriculum Development | | | | Project Name | Outreach to Academia: Facility Development | | | | Project Name | Outreach to Academia: INSuRE Summer Camps | | | | Project Name | DoW CSA Bootcamp | | | |
| Faculty and Staff | | | | | Faculty and Staff | | | | | Faculty and Staff | | | | | Faculty and Staff | | | | | Faculty and Staff | | | | |
| Position: | Name | Months | Rate | Total | Position: | Name | Months | Rate | Total | Position: | Name | Months | Rate | Total | Position: | Name | Months | Rate | Total | Position: | Name | Months | Rate | Total |
| PI | | 0 | $ - 0 | $0.00 | PI | | 0 | $ - 0 | $0.00 | PI | | 0 | $ - 0 | $0.00 | PI | | 0 | $ - 0 | $0.00 | PI | | 0 | $ - 0 | $0.00 |
| Faculty 2 | | 0 | $ - 0 | $0.00 | Faculty 2 | | 0 | $ - 0 | $0.00 | Faculty 2 | | 0 | $ - 0 | $0.00 | Faculty 2 | | 0 | $ - 0 | $0.00 | Faculty 2 | | 0 | $ - 0 | $0.00 |
| Faculty 3 | | 0 | $ - 0 | $0.00 | Faculty 3 | | 0 | $ - 0 | $0.00 | Faculty 3 | | 0 | $ - 0 | $0.00 | Faculty 3 | | 0 | $ - 0 | $0.00 | Faculty 3 | | 0 | $ - 0 | $0.00 |
| Faculty 4 | | 0 | $ - 0 | $0.00 | Faculty 4 | | 0 | $ - 0 | $0.00 | Faculty 4 | | 0 | $ - 0 | $0.00 | Faculty 4 | | 0 | $ - 0 | $0.00 | Faculty 4 | | 0 | $ - 0 | $0.00 |
| A | Total | | | | $0.00 | Total | | | | $0.00 | Total | | | | $0.00 | Total | | | | $0.00 | Total | | | | $0.00 |
| Fringe Benefits | | | | Fringe Benefits | | | | Fringe Benefits | | | | Fringe Benefits | | | | Fringe Benefits | | | |
| | $$ | Rate | Total | | $$ | Rate | Total | | $$ | Rate | Total | | $$ | Rate | Total | | $$ | Rate | Total |
| PI | 0.00 | 0.00% | $0.00 | PI | 0.00 | 0.00% | $0.00 | PI | 0.00 | 0.00% | $0.00 | PI | 0.00 | 0.00% | $0.00 | PI | 0.00 | 0.00% | $0.00 |
| Faculty 2 | 0.00 | 0.00% | $0.00 | Faculty 2 | 0.00 | 0.00% | $0.00 | Faculty 2 | 0.00 | 0.00% | $0.00 | Faculty 2 | 0.00 | 0.00% | $0.00 | Faculty 2 | 0.00 | 0.00% | $0.00 |
| Faculty 3 | 0.00 | 0.00% | $0.00 | Faculty 3 | 0.00 | 0.00% | $0.00 | Faculty 3 | 0.00 | 0.00% | $0.00 | Faculty 3 | 0.00 | 0.00% | $0.00 | Faculty 3 | 0.00 | 0.00% | $0.00 |
| Faculty 4 | 0.00 | 0.00% | $0.00 | Faculty 4 | 0.00 | 0.00% | $0.00 | Faculty 4 | 0.00 | 0.00% | $0.00 | Faculty 4 | 0.00 | 0.00% | $0.00 | Faculty 4 | 0.00 | 0.00% | $0.00 |
| B | Total | 0.00 | | $0.00 | Total | 0.00 | | $0.00 | Total | 0.00 | | $0.00 | Total | 0.00 | | $0.00 | Total | 0.00 | | $0.00 |
| Other | | | | Other | | | | Other | | | | Other | | | | Other | | | |
| | # | Cost | Total | | # | Cost | Total | | # | Cost | Total | | # | Cost | Total | | # | Cost | Total |
| Equipment | 0 | $ - 0 | $0.00 | Equipment | 0 | $ - 0 | $0.00 | Equipment | 0 | $ - 0 | $0.00 | Equipment | 0 | $ - 0 | $0.00 | Equipment | 0 | $ - 0 | $0.00 |
| Travel | 0 | $ 1,750.00 | $0.00 | Travel | 0 | $ 1,750.00 | $0.00 | Travel | 0 | $ 1,750.00 | $0.00 | Travel | 0 | $ 1,750.00 | $0.00 | Travel | 0 | $ 1,750.00 | $0.00 |
| Admin | 0 | $ - 0 | $0.00 | Admin | 0 | $ - 0 | $0.00 | Admin | 0 | $ - 0 | $0.00 | Admin | 0 | $ - 0 | $0.00 | Admin | 0 | $ - 0 | $0.00 |
| Other* | 0 | $ - 0 | $0.00 | Other* | 0 | $ - 0 | $0.00 | Other* | 0 | $ - 0 | $0.00 | Other* | 0 | $ - 0 | $0.00 | Other* | 0 | $ - 0 | $0.00 |
| Other* | 0 | $ - 0 | $0.00 | Other* | 0 | $ - 0 | $0.00 | Other* | 0 | $ - 0 | $0.00 | Other* | 0 | $ - 0 | $0.00 | Other* | 0 | $ - 0 | $0.00 |
| C | Total | | | $0.00 | Total | | | $0.00 | Total | | | $0.00 | Total | | | $0.00 | Total | | | $0.00 |
| Total Direct Costs | | Total Direct Costs | | Total Direct Costs | | Total Direct Costs | | Total Direct Costs | |
| D | A+B+C | $0.00 | A+B+C | $0.00 | A+B+C | $0.00 | A+B+C | $0.00 | A+B+C | $0.00 |
| F&A | | | | | F&A | | | | | F&A | | | | | F&A | | | | | F&A | | | | |
| | Tot. Dir. Costs (may not include participant costs, or dissertation costs.) | | Rate | Total | | Tot. Dir. Costs (may not include participant costs, or dissertation costs.) | | Rate | Total | | Tot. Dir. Costs (may not include participant costs, or dissertation costs.) | | Rate | Total | | Tot. Dir. Costs (may not include participant costs, or dissertation costs.) | | Rate | Total | | Tot. Dir. Costs (may not include participant costs, or dissertation costs.) | | Rate | Total |
| E | Percent Rate | | $0.00 | 0% | $0.00 | Percent Rate | | $0.00 | 0% | $0.00 | Percent Rate | | $0.00 | 0% | $0.00 | Percent Rate | | $0.00 | 0% | $0.00 | Percent Rate | | $0.00 | 0% | $0.00 |
TOTAL TOTAL TOTAL TOTAL TOTAL
F D+E $0.00 D+E $0.00 D+E $0.00 D+E $0.00 D+E $0.00