SECANTA – SCOPE Identifier Form

01 Organization Identification

Legal Organization Name *

DBA / Trade Name

Organization Type *

Primary Industry *

Approximate # of Employees *

Number of Physical Locations

Primary Address *

State(s) of Operation

02 Primary Point of Contact

First Name *

Last Name *

Title / Role *

Department

Email *

Phone *

Technical / IT Contact (if different)

Name

Title / Role

Email

Phone

03 IT Environment Overview

Total # of Workstations *

Total # of Servers

What platforms / services are in use? (check all)

Microsoft 365

Google Workspace

Azure / Entra ID

AWS

On-Prem Active Directory

VPN / Remote Access

Current IT Provider / MSP

Primary Line-of-Business Applications

04 Current Security Posture

Which security controls are currently in place? (check all)

Antivirus / EDR

Firewall (managed)

MFA everywhere

Email security / filtering

SIEM / log monitoring

Backup solution

Security awareness training

Vulnerability scanning

Incident response plan

None of the above

Have you experienced a breach or incident in the past 24 months?

Yes

No

Unsure

If yes, briefly describe

05 Data & Asset Classification

What types of sensitive data does your organization handle?

Customer PII

Financial / payment data

Health / PHI records

Intellectual property

Employee HR data

Government / CUI

Where is critical data primarily stored?

06 Compliance & Regulatory Context

Applicable frameworks (check all)

PCI DSS

SOC 2

CMMC / DoD

State Privacy Law

Cyber Insurance req.

FTC Safeguards Rule

None currently known

Active cyber liability insurance?

Yes

No

In process

07 Third Parties & Remote Access

Vendors access your systems? *

Yes

No

Remote work model *

All Remote

Hybrid

On-Site Only

Key third-party vendors with system access

08 Engagement Goals & Scope

Primary driver for engaging SECANTA *

Build security program from scratch

Improve existing posture

Customer/partner requirement

Qualify for cyber insurance

Respond to recent incident

Risk assessment / gap analysis

Penetration testing / red team

Ongoing vCISO / advisory

Top 2–3 security concerns

Timeline / Urgency

Immediate (<30d)

1–3 months

3–6 months

6+ months

Approximate Budget (optional)

09 Authorization & Signature

By signing below, the authorized representative confirms that the information provided is accurate and authorizes SECANTA to use it solely for delivering professional security advisory services.

Printed Name *

Title *

Date *

Organization Name *

AUTHORIZED SIGNATURE

FOR SECANTA USE ONLY | Client ID: _____________ | Received By: _____________ | Date Received: _____________

Verify Your Identity

SCOPE Identifier Form