First Name*

Last Name*

Date of Birth*

Phone Number*

Street Address*

City*

State*

Zip Code*

Country*

Military Email Address*

Email*

Family Emergency Contact

Full Name*

Relationship*

Phone Number*

Self-Reporting – (Optional: the information below was requested on the DOD SkillBridge application)

F3 invites all applicants to voluntarily report their race, gender, and ethnicity. Your responses are collected for internal data collection purposes and will not be used to determine program eligibility.

Race/Ethnicity
WhiteHispanic or LatinoBlack or African-AmericanAsianAmerican Indian or Alaska NativeNative Hawaiian or Other Pacific IslanderSome Other RaceMultiracialPrefer Not To Answer

Gender
MaleFemaleNon-BinaryOtherPrefer Not To Answer

Select your Military Status*
Active Duty within 180 days of separationActive Duty within 180 days until separationNone of the above

Branch of Service*
ArmyNavyAir ForceMarine CorpsCoast GuardSpace Force

Rank / Pay Grade*
E-1E-2E-3E-4E-5E-6E-7E-8E-9E-9 SpecialW-1W-2W-3W-4W-5O-1O-2O-3O-4O-5O-6O-7O-8O-9O-10

Please identify your military specialty below (MOS, AFSC, NEC)*

Please describe your Military Specialty below.*

Security Clearance*
ConfidentialSecretTS/SCITS/SCI with PolyOtherNone

Estimated Separation Date*

Are you within 180 days of separation?*
YesNo

Installation / Base Stationed At*
—Please choose an option—Al Udeid Air Base (Qatar)Andersen AFB (Guam)Aviano Air Base (Italy)Barksdale AFB (LA)Buckley Space Force Base (CO)Cape Canaveral Space Force Station (FL)Camp Arifjan (Kuwait)Camp Ederle / USAG Italy – Vicenza (Italy)Camp Humphreys (South Korea)Camp Lejeune (NC)Camp Pendleton (CA)Camp Zama (Japan)Cannon AFB (NM)Cheyenne Mountain Space Force Station (CO)Clear Space Force Station (AK)Coast Guard Academy (CT)Coast Guard Air Station Clearwater (FL)Coast Guard Air Station Miami (FL)Coast Guard Air Station San Francisco (CA)Coast Guard Air Station Sitka (AK)Coast Guard Base Alameda (CA)Coast Guard Base Charleston (SC)Coast Guard Base Honolulu (HI)Coast Guard Base Kodiak (AK)Coast Guard Base Portsmouth (VA)Coast Guard Headquarters (DC)Coast Guard Training Center Cape May (NJ)Davis-Monthan AFB (AZ)Dyess AFB (TX)Edwards AFB (CA)Eglin AFB (FL)Ellsworth AFB (SD)Fairchild AFB (WA)Fort Benning (GA)Fort Bliss (TX)Fort Bragg / Fort Liberty (NC)Fort Campbell (KY/TN)Fort Carson (CO)Fort Cavazos (TX)Fort Drum (NY)Fort Eustis (VA)Fort Gordon (GA)Fort Greely (AK)Fort Huachuca (AZ)Fort Irwin (CA)Fort Jackson (SC)Fort Johnson (LA)Fort Knox (KY)Fort Leavenworth (KS)Fort Lee (VA)Fort Leonard Wood (MO)Fort Meade (MD)Fort Moore (GA)Fort Myer (VA)Fort Novosel (AL)Fort Riley (KS)Fort Rucker (AL)Fort Sill (OK)Fort Stewart (GA)Grafenwoehr Training Area (Germany)Grand Forks AFB (ND)Hanscom AFB (MA)Hill AFB (UT)Holloman AFB (NM)Hurlburt Field (FL)Joint Base Andrews (MD)Joint Base Charleston (SC)Joint Base Elmendorf–Richardson (AK)Joint Base Langley-Eustis (VA)Joint Base Lewis–McChord (WA)Joint Base Myer-Henderson Hall (VA)Kadena Air Base (Japan)Keesler AFB (MS)Kirtland AFB (NM)Kunsan Air Base (South Korea)Lackland AFB (TX)Laughlin AFB (TX)Lemoore NAS (CA)Luke AFB (AZ)MacDill AFB (FL)Malstrom AFB (MT)Marine Corps Air Station Beaufort (SC)Marine Corps Air Station Iwakuni (Japan)Marine Corps Air Station Miramar (CA)Marine Corps Air Station Yuma (AZ)Marine Corps Base Camp Lejeune (NC)Marine Corps Base Camp Pendleton (CA)Marine Corps Base Hawaii (HI)Marine Corps Base Quantico (VA)Marine Corps Mountain Warfare Training Center (CA)MCRD Parris Island (SC)MCRD San Diego (CA)Maxwell AFB (AL)MCAS Iwakuni (Japan)MCAS Miramar (CA)MCAS Yuma (AZ)Minot AFB (ND)Misawa Air Base (Japan)Moody AFB (GA)Nellis AFB (NV)Naval Air Station Fallon (NV)Naval Air Station Jacksonville (FL)Naval Air Station Lemoore (CA)Naval Air Station Oceana (VA)Naval Air Station Pensacola (FL)Naval Air Station Whidbey Island (WA)Naval Base Coronado (CA)Naval Base Guam (Guam)Naval Base Kitsap (WA)Naval Base Point Loma (CA)Naval Base San Diego (CA)Naval Station Great Lakes (IL)Naval Station Mayport (FL)Naval Station Norfolk (VA)Naval Station Rota (Spain)Naval Submarine Base Kings Bay (GA)Naval Submarine Base New London (CT)Naval Support Activity BahrainNaval Support Activity Naples (Italy)Naval Support Activity Souda Bay (Greece)Nelson AFB (NV)NSA Bahrain (Bahrain)Offutt AFB (NE)Osan Air Base (South Korea)Panzer Kaserne (Germany)Patrick Space Force Base (FL)Peterson Space Force Base (CO)PIC – Picatinny Arsenal (NJ)Pleasanton Naval Base (CA)Portsmouth Naval Shipyard (ME)Puget Sound Naval Shipyard (WA)Ramstein Air Base (Germany)Redstone Arsenal (AL)Robins AFB (GA)Rock Island Arsenal (IL)Sasebo Naval Base (Japan)Schriever Space Force Base (CO)Scott AFB (IL)Shaw AFB (SC)Sheppard AFB (TX)Spangdahlem Air Base (Germany)Stuttgart Army Garrison (Germany)Thule Air Base (Greenland)Tinker AFB (OK)Travis AFB (CA)Vandenberg Space Force Base (CA)Vilseck Army Base (Germany)Wiesbaden Army Garrison (Germany)White Sands Missile Range (NM)Wright-Patterson AFB (OH)Yokosuka Naval Base (Japan)Yokota Air Base (Japan)

Type of Discharge*
Active DutyHonorableGeneral (Under Honorable Conditions)Other Than Honorable (OTH)Bad ConductDishonorableEntry-Level Separation (ELS)

Command / Unit Information*

Supervisor / Command POC Name*

Supervisor / Command POC Email*

Has your command approved participation in SkillBridge?*
Yes, verballyYes, in writingPending approvalNo

Career Counselor or SkillBridge Counselor details

Career Counselor Name*

Career Counselor Phone Number*

Career Counselor Email*

Upload Command Approval Memorandum (if available)

Have you previously worked in IT or cybersecurity roles?*
YesNo

What is your highest level of education?*
High School / GEDSome CollegeAssociate DegreeBachelor’s DegreeMaster’s DegreeDoctorateOther

Select the certifications you currently hold (if any)*
Security+Network+A+CYSA+CEHCCNAITILNoneOther

Rate your comfort level with technology*
BeginnerLearnerCompetentSkilledExpert

Why are you interested in the DoD SkillBridge Cybersecurity Program?*

What cybersecurity career roles are you most interested in?*
SOC AnalystCybersecurity AnalystIncident ResponseGRC / CompliancePenetration Testing / Ethical HackingNetwork SecurityCloud SecurityNot Sure Yet

Describe your short-term professional goals (1–2 years).*

Describe your long-term professional goals (5 years).

Preferred Program Start Date*
05/04/2026 – 07/17/2026 (Orientation TBD)08/10/2026 – 10/16/2026 (Orientation TBD)

AVAILABILITY & LOGISTICS

Are you available for full-time participation during SkillBridge?*
YesNo

Are you able to attend training in person, remotely, or both?*
In-PersonRemoteBoth

DOCUMENT UPLOADS

Upload Resume

FINAL ATTESTATIONS

I hereby certify that all the information I have provided herein is true and accurate.
I acknowledge that SkillBridge participation requires command approval.

Electronic Signature*

Today's Date*

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