Historically Underutilized Business (HUB) Operations Department
Protégé Application for Enrollment in Mentor-Protégé Program
Please confirm that your company meets the minimum requirements outlined below:
 Is a State of Texas HUB HUB Vendor Number:_______________________
 Has been in business for at least one year
 Agree to sign a written agreement to discuss business practices with the mentor
 Is in “good standing” with the State of Texas
Signature__________________________________________ Date: ___________________
Applicant Protégé Business Name:
Mailing Address:
Telephone Number:
E-mail:
Owner(s):
Fax Number:_________________________
Website:
If your business concern has been in operation for three years or longer, please provide the annual gross receipts for the last three fiscal years for this business concern and its subsidiaries and affiliates:
Fiscal Year Annual Gross Revenue
20 _ _
20 _ _
20 _ _
Check the categories where you need assistance:
 Banking services
 Bonding & insurance
 Business Plan
 Construction equipment & materials
 Contracts
 Cost Accounting
 Action plans and implementation
 Job cost & work-in-progress
 Market analysis
 Obtaining permits & subcontracts
 Organization structure
 Payroll (federal, state fringe benefits)
 Finance. Please specify:
 Website development. Please specify:
 Other:
 Personnel management
 Preparing & negotiating change orders
 Project planning & scheduling
 Prompt payment procedures
 Reading & interpreting plans & specifications
 Records & contract management
 Scheduling & purchasing
 Troubleshooting and avoidance delay
 Account records preparation & maintenance

Payee Identification Number: Provide the taxpayer identification number assigned to you for the purpose of filling your business’ federal income tax return.
Taxpayer Identification Number
State your reasons for wanting to participate in the Mentor Protégé Program. Expand upon the category checklist in your statement, describing your goals.
Business start date:
Number of full-time employees:
Principle Line of Business:
Number of part-time employees:
Legal structure of business:
Corporation
Partnership
Sole Proprietorship
Other (Specify)
Please list major customers for the last two years (list most recent first). If your business is new, list previous business references.
Customer Telephone Contact Year $ Value
Submission of this application enables your firm to be considered for University of Houston’s
Mentor-Protégé program. It is not a guarantee of selection. The information contained in this form will only be shared with prospective mentors for matching purposes. Send via fax to 713-743-5672 or via email with Subject Line- Mentor Protégé Application to mpthornton@uh.edu
DO NOT WRITE BELOW THIS LINE
Date reviewed:
Comments:
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