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What is the ownership structure of the company considering 8(a) or SDB certification?
 Sole Proprietorship Partnership Limited Liability Company Corporation Other (please describe)

Please give a brief description of the main product/service the company provides.

Has this company ever been previously 8(a) certified?  yes no

Have any of the owner/applicant(s) whom 8(a) or SDB certification eligibility will be based on ever been previously 8(a) certified? yes no

Are the owner/applicant(s) U.S. Citizens? yes no

Are the owner/applicant(s) majority owners (51% ownership or greater) of the company? yes no

Which of the following categories apply to the owner/applicant(s)?
 American Women Subcontinent Asian Americans Black Americans Hispanic Americans Native Americans Service Disabled Veteran Asian Pacific Americans Subcontinent Asian Americans

Which of the following certifications does your company currently hold? (Check as many as applicable.)
 Women Minority HubZone DBE State City County None Other

Has the company been in business for two or more years? yes no

Is the company considered a small business by applicable size standards for your industry? yes no

Do owner/applicant(s) work full-time (40 or more hours per week) in the business? yes no

Do owner/applicant(s) have full and complete control of the company and all decisions made regarding the company? yes no

Is this company operated for-profit? yes no

Do the owner/applicant(s) have ownership interest of another business? yes no

Are the owner/applicant(s) employed by any other company? yes no

Have the owner/applicant(s) been subjected to discrimination in the U.S. because of race, ethnicity, gender, physical disability or geographical location of residence or upbringing? yes no

Does owner/applicant or company have any past due or unpaid debts (taxes, loans, etc.) to the government? yes no

If owner/applicant(s) answered yes to the above question can they supply proof that payment arrangements been made and payments are being kept current? yes no n/a

Is owner/applicant(s) of good moral character? yes no

Is this company a brokerage firm? yes no

Does this company have any joint venture, licensing, alliance or teaming agreements with other companies? yes no

Excluding the value of the business and personal residence, does owner/applicant have an adjusted net worth of $250,000 or less? yes no

Does the applicant meet the regulated Adjusted Gross Income (AGI) (minus spouse’s income) of $350,000 for an average of the past 3 years? (Review line 37 of your personal tax returns) yes no