Registration Form for Military Engineering Data Assett Locator System
(MEDALS) for U.S. Government Employees

 Instructions for completing this form

Please TYPE or PRINT CLEARLY then mail or fax this form to:

Mail:                                                                             FAX:
DLIS-VSM (MEDALS Access)                                        DSN 661-5925
Defense Logistics Information Service                              Commercial (269) 961-5925
74 Washington Ave N Ste 7
Battle Creek MI 49017-3084

This is a Department of Defense (DoD) computer system. DOD computer systems are provided for the processing of official U.S. Government information only. All data contained on DoD computer systems is owned by the Department of Defense, may be monitored, intercepted, recorded, read, copied, or captured in any manner and disclosed in any manner, by authorized personnel. There is no right to privacy in this system. System personnel may give to law enforcement officials any potential evidence of crime found on DoD computer systems. Use of this system by any user, authorized or unauthorized, constitutes consent to this monitoring, interception, recording, reading, copying, or capturing and disclosure.

U.S. Government Branch of Service or Agency:____________________
(Such as Army, Navy, Air Force, DLA, GSA, NASA, etc.)

Major Command:______________________________________________
(Such as Army Materiel Command, Air Force Materiel Command, Naval Supply Command, etc.)

 POC Name:________________________________________________

Office Symbol, Code, Mail Stop:_______________________________

Organization:_______________________________________________

Street/PO Box_______________________________________________

City/State/Zip Code:__________________________________________

City/Country (if APO or FPO address:___________________________

Commercial Phone:________________ DSN:_____________________

E-Mail Address:_____________________________________________

FAX:______________________

Block 2. MEDALS User Information

This form requests that you provide your social security number. The U.S. Government is authorized to ask for this information under Executive Orders 9397, 10450 and 10577 sections 3301 and 3302 of title 5, U.S. Code and parts 4, 731 and 736 of Title 5, Code of Federal Regulations. Your social security number is needed to keep records accurate, because other people may have the same name. The primary use of the information on this form is for review by Government Officials to determine and verify that you have the appropriate security clearance to obtain access to the requested data. Disclosure is voluntary. However, failure to provide the requested information may result in denial of access.

As a user of MEDALS, I acknowledge my responsibility to conform to the following requirements and conditions as established by DLA.

I understand the need to protect my password. I will NOT share my password and/or account.

I understand that I am responsible for all actions taken under my account. I will NOT attempt to ‘hack" the network or any connected information system or network, or attempt to gain access to data for which I am not specifically authorized.

I acknowledge my responsibility to comply with all copyright laws both federal and state (where applicable).

I understand my use of DLA information systems is subject to monitoring to ensure proper functioning, to protect against improper or unauthorized use or access, and to verify the presence or performance of applicable security features or procedures. By using the information system I consent to such monitoring.

I acknowledge my responsibility to conform to the requirements stated above when using DLA information systems or networks. I also acknowledge that failure to comply with these requirements and conditions may constitute a security violation resulting in denial of access to DLA information systems, networks or facilities and that such violations will be reported to appropriate authorities for further action as deemed appropriate.

I understand the need to protect my password. I will NOT share my password/and/or user ID. If I no longer need access to MEDALS, it is my responsibility to notify DLIS.

USER SIGNATURE___________________________DATE:______________

Printed Name:___________________________________________________

Social Security Number:___________________________________________

DLA Standard LOGON:__________________Email:_____________________

Commercial Phone:_______________________DSN:___________________

Personal Identification Information – (This may be your favorite color, sports team, hobby or phrase.) ________________________________________________________

Block 3. Security Verification

This block must be completed by your Command Security Office. Requests received without annotation and signature will be returned without further action.

Security Officer.  Access to this system requires the user to have a National Agency Check  (NACI) or equivalent type of Investigation.  If this level of investigation has not been completed for this person, contact the Defense Security Service at http://www.dss.mil for assistance.

Verification of Security for requester named in Block 2:

Employee Name:_____________________________________________

Type of Investigation:_____________ Completed on:_______________

By (Agency):_________________________________________________

Signature of Security Representative:____________________________

Typed Name of Security Representative:__________________________

Title:__________________________________ Date:_________________

Commercial Phone:_______________________ DSN:_______________