DCMA Form Updated July 2021

Mentor Questionnaire 

DCMA Annual Review DoD Mentor Protégé Agreement

(Mentor 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: ______________

1. Developmental Assistance Provided:

Assistance to be Provided

Based on Agreement

Assistance Provided Based on 

Discussions with Mentor/Protégé 

Business Infrastructure 

Development 

Business Infrastructure 

Development

Marketing Support Marketing Support

Manufacturing Training Manufacturing Training

Quality Training Quality Training

Engineering/Technical Training Engineering/Technical Training

Equipment Provided Equipment Provided

Financial Assistance Financial Assistance

Other: (Specify) Other: (Specify)

2. Contract Obligation/ Payment History: 

a. Total Obligated Amount: $___________ ( Reimbursable Agreements) 

b. Total Approved Amount: $ ___________(Credit Agreement)
Mentor Questionnaire

DCMA Form Updated July 2021

c. Contract/Modification Information:

Please provide copies of contract and modifications as supporting documentation if they 

have not been provided previously. 

d. Invoice Information:

e. Cumulative Amount INVOICED $__________________________

Please provide copies of vouchers as supporting documentation if they have not been 

provided previously. 

 

3. Expenditures during Annual Review:

Expenditures

Expenditures 

during Review 

Period

Cumulative from Start

HBCU/MI $ $

PTAC/SBDC/MEP/WBC $ $

Employee Labor $ $

Other Direct Costs $ $

Property $ $

Contract/Modification 

Number Year Date of Document

Obligated 

Dollars

Remarks; (List if Admin Only, 

Increase Funds, Decrease 

Funds)

Yr 1

Yr 2

Total 

Voucher Number Year Date on Voucher Dollar Amount

Base 

Option 1

Total 
Mentor Questionnaire

DCMA Form Updated July 2021

Expenditures Worksheet:

Expenditures during Review Period: This data should MATCH the data provided on the 

Semi-Annual Reports applicable to this review period. If your numbers do not match, please 

explain in (a) below. This may mean the SARs will need to be updated.

a. Does the expenditures reported during the Annual Review match the expenditures reported 

on the Semi Annual Reports submitted for the review period? Yes ____ No_____

If not, please explain the difference in detail.

4. Summary of Work Completed during this review period:

NOTE: Please provide updated Gantt chart as supporting documentation if they have not 

been provided previously? 

 a. Did you follow the Gantt chart or Work Breakdown Structure (WBS) provided with 

 the Technical Proposal? Yes_____ or No_____ 

 

b. Have they changed? Yes _____ or No _____ (If so, please provide the approved 

 Updates to the DCMA SBP)

c. Were the changes approved by the Servicing Agency or DCMA? 

 Yes______ NO______ N/A _______

d. Where there any changes to the Cost Proposal and if so, were the changes approved by 

 the Servicing Agency or DCMA? Yes______ NO_______ (if so, please provide the 

 approved updates to the DCMA SBP)

Expenditures Employee

Labor

PTAC/SBDC/

MEP/WBC 

HBCU/MI Other Direct 

Cost

Property

SAR 10/1 – 3/31 (BY) $0 $0 $0 $0 $0

SAR 4/1 – 9/30 (BY) $0 $0 $0 $0 $0

SAR 10/1 – 3/31 (OY I) $0 $0 $0 $0 $0

SAR 4/1 – 9/30 (OY I) $0 $0 $0 $0 $0

Cumulative from Start $0 $0 $0 $0 $0
Mentor Questionnaire

DCMA Form Updated July 2021

e. List all the milestones/task completed during this review period, as listed on the

 Gantt chart or WBS and Semi-Annual Review (SAR). 

f. Explain in detail what the task did and how did it enhance or improve the Protégé’s 

 capabilities. (Spell out all Acronyms) 

g. List all Remaining Tasks and Schedule Status: (ie. On Schedule)

Revised Task Justification – list any revision/change request that have been approved and 

submit revised Gantt chart or WBS reflecting the changes to DCMA SBP. 

Revision 

Request # 

(i.e. 01, 02, 

03, etc)

Approval 

Date

Addition/

Modified/Deleted Remarks
Mentor Questionnaire

DCMA Form Updated July 2021

5. Summary of Milestones:

a. Agreement Total Milestones: ___ Milestones due This Review Period: ___ 

 Milestones Met This Review Period: ___ Milestones Missed This Review Period: ___ 

b. Provide a detailed explanation of missed milestone(s).

c. Do you have a corrective action plan? Yes _____ No_____ If yes, explain the plan in detail.

6. Mentor Comments on Agreement:

6. Expenditures: Name of Institution, if applicable and amount expended to date

• Historically Black College or University (HBCU):

• Minority Institution of Higher Education(MI):

• Procurement Technical Assistance Center (PTAC):

• Small Business Development Center (SBDC):

• Manufacturing Extension Partner (MEP)

• Women’s Business Center (WBC)

a. What is/are the cumulative dollars for each of the above institution(s) from the start of 

the agreement?
Mentor Questionnaire

DCMA Form Updated July 2021

b. List the developmental assistance provided by the above institution(s) and provide a 

detailed description of each service or training:

7. How did it benefit the protégé to compete on a stand-alone basis?

 8. Property:

a. Was property provided to the protégé during this MPA? 

b. If so, please provide a list to include cost of the government furnished equipment (GFE);

 Contractor acquired property (CAP), property purchased and reimbursed by the 

 government; and provided to protégé. 

c. What happens to the property at the end of this MPA? 

8. What was the Value to Department of Defense and the War Fighter?

9. Other comments you would like to provide.

Name & Title________________________________________ Date: ___________