Office of Small and Disadvantaged Business Utilization

Treasury's Mentor-Protégé Program

Application

A signed mentor-protégé application for each mentor-protégé relationship should be submitted to the Office of Small and Disadvantaged Business Utilization (OSDBU) for approval. The application should be in narrative form and include, at a minimum, the following information in the format shown below:

Mentor Firm Information. Provide the following:

• Name of Firm
• Contact Name
• Position Title
• Address
• Telephone
• Fax
• E-Mail
• Homepage

• Name of Firm
• Contact Name
• Position Title
• Address
• Telephone
• Fax
• E-mail
• Homepage

• A Small business concern that meets the definition at FAR 19.001, based on its primary  NAICS code is eligible to be a protégé firm. SBA Regulations/FAR Provision: FAR 19.001; 13 CFR Part 121; 13 CFR 124.1002
• The protégé firm's primary NAICS code is______________.
• The Protégé represents, for general statistical purposes that it is a ___small, ___very small, ___small disadvantaged, or ___8(a) business concern as defined above.
• The Protégé should also identify the category in which its ownership falls: ___Black American, ___Hispanic American, ___Native American, ___Asian Pacific, ___Subcontinent Asian, or ___Individual concern, other than one of the preceding.
• The Protégé represents that it ___is, ___is not a HUBZone small business concern listed, on the date of this representation, on the List of Qualified HUBZone small business concerns maintained by the Small Business Administration.
• The Protégé represents that it ___is, ___is not a women-owned small business concern.
• The Protégé represents that it ___is, ___is not a Veteran-owned small business concern
• The Protégé represents that it ___is, ___is not a Service Disabled Veteran-Owned Small Business concern.

• Management guidance relating to-
• Financial management
• Organizational management
• Overall business management/planning and
• Business development
• Technical assistance
• Rent-free use of facilities and/or equipment
• Property
• Temporary assignment of personnel to the protégé firm for the purpose of training
• Loans; and
• Any other types of mutually beneficial assistance

Milestones. Define milestones for providing the identified developmental assistance.

Metrics. In addition to the developmental assistance plan, provide factors to assess the protégé firm's developmental progress under the Program.

Subcontract Awards to Protégé(s). The number and total dollar amount of subcontract awards made to the identified protégé firm(s) during the two preceding fiscal years (if any).

Estimate of Cost. Provide an estimate of the total cost of the developmental assistance.

Program Participation Term. State the period of time over which the developmental assistance will be performed.

Potential Subcontracts. Provide the anticipated dollar value and type of subcontracts that may be awarded to the protégé firm consistent with the extent and nature of mentor firm's business, and the period of time over which they may be awarded.

Mentor Termination Procedures. Describe the procedures for the mentor firm to notify the protégé firm in writing at least 30 days in advance of the mentor firm's intent to voluntarily withdraw its participation in the Program.

Protégé Termination From the Program. Describe the procedures for a protégé firm to notify the mentor firm in writing at least 30 days in advance of the protégé firm's intent to voluntarily terminate the mentor-protégé agreement.

Other Termination Procedures. Describe the procedures for the mentor firm to terminate the mentor-protégé agreement for cause which provide:

• The protégé firm shall be furnished a written notice of the proposed termination, stating the specific reasons for such action, at least 30 days in advance of the effective date of such proposed termination.
• The protégé firm shall have 30 days to respond to such notice of proposed termination, and may rebut any finding believed to be erroneous and offer a remedial program.
• Upon prompt consideration of the protégé firm's response, the mentor firm shall either withdraw the notice of proposed termination and continue the protégé firm's participation, or issue the notice of termination.
• The mentor firm shall submit a plan for accomplishing work should the agreement be terminated.

Signed Agreement. Mentors and Protégés are asked to sign and date the agreement. The parties shall state they agree to comply with the obligations in section 1019.202-7.14 of the DTAR and all other clauses and provisions governing the program. Titles of the individuals should also be included as shown in the following example:

Mentor	Protégé
Printed Name	Printed Name
Signature	Signature
Title	Title
Date	Date

For additional information on Treasury's Success Partnerships Mentor-Protégé Program, please contact:

Robin Byrd
Mentor Protégé Program Manager
Department of the Treasury
Office of Small and Disadvantaged Business Utilization
1500 Pennsylvania Avenue, NW
Mail Code: 655 15th Street/6091
Washington, DC 20220
Phone: (202) 622-8213
Fax: (202) 927-4963

Updated February 29, 2008