Prospective Partner Capability Form

1. Company Name*
2. Address*
3. Other Locations (if none, indicate N/A)*
4. Internet Address*
5. Contact Name*
6. Contact Email*
7. Phone Number*
8. U.S. Owned (Y/N)*
9. DUNS#
10. Cage Code
11. NAICS Code
12. Capabilities Statement (two page maximum)
13. Business Classification (select all that apply)*
- Women-Owned Small Business
- Historically Black College/University
- 8A Small Disadvantaged Business
- Service-Disabled Veteran-Owned Small Business
- HUBzone Small Business
- Veteran-Owned Small Business
- Small Disadvantaged Business
- Mid-Tier Business
- Large Business
14. Identify any certification(s) (ex. CMMI)
15. Current/Past Performance
If you currently provide or have provided products/services to a government agency, please indicate agency name, dates, and contract vehicle (if applicable).
If you currently provide or have provided products/services to a commercial entity, please indicate business name and dates.

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