MITRE

Form A

Public Release Approval Endorsements

for non-MITRE Authored Information

U.S. Authors (excluding US Government Employees)

Applicability

Part 1 must be completed for all material submitted by US Authors (excluding US Government Employees). Additionally, either Column A or Column B of Part II must be completed. If Part II Column B is completed, then

Part III is required.

The Author(s) hereby warrants that the material submitted to MITRE is not copyrighted by a third party; or if it is copyrighted by a third party, that party has provided prior written approval to the Author for submission of such material to MITRE. To support this warranty, the Author(s) agrees to indemnify and hold harmless The MITRE Corporation for all liability, damages and attorney fees that may be incurred in any legal action connected with copyright infringement involving the material produced or provided.

Title of submission

Part 1 – Author and Company or University First Endorsement
Signature in Part 1 certifies that author and co-authors(s),
if any, have received all company or university required approvals.
Note:
For jointly authored material, only one signature is required, however, all co-authors need to be advised of the above terms (i.e., they also need to have received all required approvals prior to signature) and agree with the column selected/signed in Part II.
Part II – Author and Company or University Second Endorsement

Column A

By signing below, the author certifies that all information used in preparing this material was derived from unclassified/open sources and that no information was used from work performed or derived under a US Government contract or US Government grant. (Part III is not required when the author signs Part II, Column A).
Author’s Signature Date
Part III – US Government Public Affairs Office Endorsement
Part III is required for unclassified material to be posted on a MITRE public web page or presented at a MITRE hosted conference when Part II, Column B is signed. Part III is to be completed by a US Government individual authorized to release and clear information for open publication or public disclosure (e.g., security review officer).

Releasing Official

Your signature authorizes public release of this unclassified material and its inclusion on a MITRE public web page or presented at a MITRE hosted conference.
Name of US Government Releasing Official (Print or type) / Author (Print or type)
Author’s Phone Fax
Company/University Name
Mailing Address
City, State, Zip
Author’s Signature Date

Column B

For work performed or derived under a US Government contract or grant, complete the following.
Contract or Grant Number
US Government Agency Awarding Contract or Grant
Author’s Signature Date
Official’s Title
Official’s Phone
Company/Organization
Mailing Address
City, State, Zip
Releasing Official’s Signature Date

MITRE Information Security ApprovalRelease Number

Approved for Public Release: 10-4358. Distribution Unlimited