DCMA Form Updated July 2021 

 

PROTÉGÉ QUESTIONNAIRE

DCMA Annual Review DoD Mentor Protégé Agreement

(Protege Questionnaire must be returned by the deadline or it will affect the rating. 

Incomplete forms will be retuned, therefore please answer all questions thoroughly)

Date:

 

Mentor Firm Name: 

Protégé Firm Name: _____________________________ 

Period of Performance Covered By Review: 

Mentor Protégé Agreement Start Date: _____________ End Date: ______________ 

Contract Number/Delivery order/Task Order (if Reimbursable agreement):

_____________________ 

Protégé Cage Code: ______________ DUNS No: _____________________ 

Small Business Category: ________________________________________ 

Type of Certifications: (SB, SDB, WOSB, SDVOSB, Hub Zone, etc.) and Expiration 

dates required: ______________ 

Did you have any business size or small business certification updates since your last 

certification? ______________ 

List All NAICS Codes:

• Primary: 

• Secondary or Additional NAICS Codes: 

• Which NAICS Code(s) is/are applicable to this agreement? 

• Identify all NAICS Codes that qualify you as a large business: 

Protégé Contact Information (Name): Title:

Phone Number: ____________________ Email: ______________________________ 
DCMA Form Updated July 2021 

Type of Developmental Assistance Provided by Mentor:

(If answers are YES, please explain in detail what assistance/training was provided 

for the developmental assistance below)

Business Infrastructure Development: Yes _____ No____ 

Detailed Explanation: 

Marketing Support: Yes _____ No____ 

Detailed Explanation: 

Manufacturing Training: Yes _____ No____ 

Detailed Explanation: 

Quality Training: Yes ___ No____ 

Detailed Explanation: 

Engineering/Technical Training: Yes ___ No___ 

Detailed Explanation: 

Cyber Security Training: Yes ___ No 

Detailed Explanation: 

Technology Transfer: Yes ___ No___ 

Detailed Explanation: 
DCMA Form Updated July 2021

Unreimbursed cost incurred by Protégé: Yes _____ No____

Detailed Explanation:

 

Certification/Awards Received: Yes ___ No___ (please provide copies to DCMA PM)

Equipment Provided by Mentor: Yes ___ No___

Has there been government equipment or property provided to you (Protégé) by the 

mentor under this DoD MP Program? If so, please provide details. 

New Markets Realized: Yes ___ No___

If so, please List and describe relationship.

Other Assistance provided not mentioned above: Yes ___ No___

Detailed Description:

Overall Status (health) of your MP Agreement: 

Detailed Description:

Benefits of the MP Agreement to your firm: Detailed Description:

DoD Subcontractor to Mentor: Yes ___ No___ 

Provide list of contract numbers by date and amounts (section I spreadsheet).

DoD Subcontractor to Prime Contractor Other Than Mentor: Yes ___ No___

Provide list of contract numbers by date and amounts (section I spreadsheet).
DCMA Form Updated July 2021 

Accomplishments/Milestones under the MP Agreement: 

Milestones Met: Yes ___ No___ 

If answer to above question is no, do you and Mentor have a corrective action plan? 

Yes ___ No___ If yes, provide the details of the corrective action plan. 

GROWTH

 Explain any and all Business growth and enhanced capabilities during this period of 

review:

Do you attribute your growth to the Mentor Protégé Agreement? Yes_____ No_____ 

Explain your answer.

Please explain in detail:

If your answer to above statement is no, why did the Mentor Protégé Agreement not grow 

your business? Explain: 

Return on Investment: Please submit back-up documents with this questionnaire (AGR 

verification, section I spreadsheet with employee list and prime/subcontract awards with date of 

award, amount & Contractor name, Services (i.e. Army, AF, Navy, etc. or Any Other Federal 

Agencies excluding DoD; such as DoE, VA, etc.

(Current Annual Gross Revenue is the amount received during the BY or OYI of 

agreement) 

Protégé Data At Start of Agreement

This Reporting 

Period Cumulative

Employees

Annual Gross Revenues
DCMA Form Updated July 2021 

Additional Comments/Concerns/Suggestions/Improvements to your MP Agreement 

and or DoD MP Program: 

What is the Value to DoD and the War Fighter?

Protégés Actual Contracts Executed to 

include any delivery or task orders 

awarded under IDIQ:

At Start of 

Agreement

Contracts/

Subcontracts 

Awarded During 

Review Period

Cumulative from 

Start of 

Agreement

DoD Prime Contract Awards to Protégé $0 $0 $0

DoD Subcontracts from Mentor to Protégé $0 $0 $0

DoD Subcontracts to Protégé from All 

Other Sources Other than Mentor $0 $0 $0

DoD Subcontracts from Protégé to Mentor $0 $0 $0

DoD Subcontracts from Protégé to Other 

Than Mentor $0 $0 $0

Other Federal Prime Federal ContractsAll Other Federal (Excluding DoD) Prime 

Awards to Protégé

$0 $0 $0

Other Federal Subcontracts- All Other 

Federal (Excluding DoD) Subcontract 

Awards to Protégé from Mentor

$0 $0 $0

Other Federal Subcontracts - All Other 

Federal (Excluding DoD) Subcontract 

Awards to Protégé from All Sources Other 

than Mentor

$0 $0 $0

Other Federal Subcontracts - All Other 

Federal (Excluding DoD) Subcontract 

Awards to Mentor from Protégé

$0 $0 $0

Other Federal Subcontracts - All Other 

Federal (Excluding DoD) Subcontract 

Awards from Protégé to Other Than 

Mentor 

$0 $0 $0
DCMA Form Updated July 2021

NAME & Title: ________________________________ Date: ________________