Form Gsa 3695 - Mentor-Protege Program Application - 2009 Page 3
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54. Eligibility of Protégé (519.7010(b)).
Provide a statement certifying that the company is
currently eligible pursuant to the following criteria:
(a) Must be a small business, veteran-owned small business, service-disabled veteran-owned small
business, HUBZone small business, small socially and economically disadvantaged business, and women-
owned small business (See SBA Regulations: 13 CFR 124, 125 and 126 and GSAM 519.7007(a)(1)). The
Protégé represents that it is (check all that apply):
Small business concern
Small Disadvantaged business concern
8(a) small business concern
Women-owned small business concern
Veteran-owned small business concern
Service disabled veteran-owned small business concern
HUBZone small business concern and is on the List of Qualified HUBZone small business concerns maintained by the
Small Business Administration
(b) Must be small as determined by the requirements of the specific NAICS code. Protégé’s primary NAICS code
(See 519.7007(a)(2)).
is eligible, as of the date of this application, for award for federal contracts
(c) The Protégé represents that it
(See 519.7007(d)(3)).
5. Developmental Assistance Program (See 519.7010(c)).
Describe the development
program for the protégé firm specifying type of assistance planned. Types of developmental
assistance a mentor firm can provide to a protégé firm may include:
Management guidance relating to financial management, organizational management, overall business
management/planning and/or business development.
Total Subcontract Awards to Protégé
Fiscal Year
Number
Dollar Amount
FY-
$
FY-
$
GSA 3695 9/2009 PAGE 3
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Parent category: Financial