Standard Form 86
Revised June 2024

Section 30 - Video Gaming Product Record
23.1 In the last seven (7) years have you participated in any video gaming product?
[ ] YES [ ] NO

Entry #1
Video gaming product name:
Dates of use:
Provide nature of participation in this video gaming product:

Was your participation while possessing a security clearance?
Do intend to participate in this video gaming product in the future?
Provide an explanation why you intend or do not intend to participate with this video gaming product in the future: