Form Gsa 3695 - Mentor-Protege Program Application - 2009 Page 5
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512. Signed Agreement
. Mentors and Protégés are asked to sign and date this agreement. The
parties shall state they agree to comply with the obligations in all clauses and provisions governing
the program.
Mentor
Protégé
Printed Name
Printed Name
Signature
Signature
Title
Title
Date
Date
Public Burden Statement
Public reporting burden for this collection of information is estimated to average 3 hours, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information for the application and the reporting requirement. The
Agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden, to the GSA
Office of Small Business Utilization (E), 1800 F Street, NW, Washington, DC 20405.
GSA 3695 9/2009 PAGE 5
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