Mentor Protege Program Application

Mentor Application

Complete form & upload applicable documents.
IMPORTANT - This form must be completed in one-sitting. You cannot save progress as you go along.

Please review the entire form BEFORE starting your application to determine what documents/information you need to have on-hand.
Business Name*
DBA (if applicable)
Supplier Number*
This number can be found in your iSupplier profile.
Eligibility

Answer the following questions about your business. Additional documentation may be requested at the discretion of the business development officer.
Does your business have a significant presence in Nashville-Davidson County or the surrounding region? *
Has your business operated continuously for the most recent five (5) years? *
Has your business had more than $5,000,000 in gross receipts for each of the most recent five (5) years? *
Annual Business Tax Returns*

Upload your annual business tax returns for each of the most recent five (5) years.
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Has your business had more than 30 full-time employees, excluding independent contractors and/or temporary agency workers, for each of the most recent five (5) years? *
Has your business performed satisfactorily as a prime contractor on at least three (3) Metro projects during the most recent five (5) years?*
If the answer is 'yes,' please complete table 1.0
Quarterly Business Tax Returns (Form 941)*

Upload your quarterly business tax returns for each of the most recent four (4) quarters.
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Table 1.0*

	Contract Number	Date Complete	Metro Department	Metro Contact
Project #1
Project #2
Project #3

Executive Letter of Commitment

Provide the following information demonstrating commitment at the executive level of your business to the mentor protege program.
Executive Level Contact*

First NameLast Name
Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
By affixing my signature below, I attest that the executive named above is committed to our business' participation as a mentor and will make both themself and company resources available to the assigned protege firm for not less than 24-months.
Signature*

Clear
Name of Individual Signing for Executive*

First NameLast Name
Designation of Company Representative

Provide the following information for the individual who will serve as the point of contact on all matters related to the mentor protege program.
Point of Contact*

First NameLast Name
Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
By affixing my signature below, I attest that the individual named above will serve as the company representative and point of contact for all things related to our business' participation in the mentor protege program and will make both themself and company resources available for not less than 24-months.
Signature*

Clear
Name of Individual Signing for Company Representative*

First NameLast Name
Inventory of Available Resources

Provide the following information about resources your business will make available to the assigned protege firm.
How much, in terms of real dollars, will your firm budget to assist the protege during the 24-month term of the program? *
How many hours per month will your firm dedicate to assist the protege during the 24-month term of the program? *
Check all areas where your business can provide meaningful education, resources, and mentorship to the assigned protege firm:*

Accounting & Financial PlanningBonding & InsuranceBusiness Plan DevelopmentContract DevelopmentCost EstimationDispute ResolutionHuman ResourcesMarket AnalysisMarketing & CommunicationsNegotiationsPayrollPermittingProject Management & SchedulingPrompt Pay ProceduresRecords ManagementRFP/RFQ Response WritingTechnologyOther
For the areas checked above, please provide specific detail about the resources your business will make available to the protege firm:*
Statement on Equity & Inclusion

Provide the following information relative to your businesses approach to equity & inclusion.
Does your business have a specific program to promote the use of any of the following types of firms? (check all that apply)*

Black/Brown Owned Businesses (MBE)Women Owned Business (WBE)LGBT Owned Businesses (LGBTBE)Service Disabled Veteran Owned Businesses (SDV)Small Businesses (SBE)None of the above.Other
If your business has a specific program to promote the use of any of the firm types enumerated above, provide further detail below about the goals, administration, and results of said program.
Does your business have an employee dedicated specifically to diversity, equity, and inclusion, and/or supplier diversity efforts?*

Yes.No.
Briefly explain your business' philosophy and approach to supplier diversity. *
Should be Empty:

Mentor Application

Eligibility

Executive Letter of Commitment

Designation of Company Representative

Inventory of Available Resources

Statement on Equity & Inclusion