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Mentor Progress Report Sample

A separate written progress report must be submitted by the mentor-protégé team for the June 30 and December 31 reporting period and conclusion of the agreement. The progress report must be electronically submitted to mentorprotege@hhs.gov.

OSDBU Tracking Number:

This report is to be completed by the MENTOR.

Instructions:
This form is intended to assist the U.S. Department of Health and Human Services (HHS) in strengthening the Mentor-Protégé Program.

Mentor Company Name:
Mentor DUNS Number:
Protégé Company Name:
Mentor Agreement Start Date: (mm/dd/yyyy)
Reporting Period
    From:          To:

  1. Please provide a brief summary of the interactions, which have taken place between your company (Mentor) and the small business (Protégé) during this reporting period? Indicate the approximate amount of time for each activity, as well as the type of developmental assistance provided to the Protégé’s company.

Type of Interaction

Duration of Interaction

Monthly

Weekly

Other

 Meetings

        

           

          

 Phone calls

  

           

          

 Conferences

        

           

          

 

  1. During this reporting period, how and what activities of the mentoring experience were beneficial to your company?
  2. Do you plan to continue or revise the activities outlined in the approved “Mentor-Protégé Agreement’s Schedule of Mentoring Activities Form?”
  3. Describe the type of developmental assistance (business, and/or technical assistance), your company provided to the Protégé during this reporting period.
  4. Identify any HHS non-competitive contracts awarded to the Protégé during this reporting period (list Contract and Task Order Number).
  5. Identify any HHS competitive contract/subcontract awarded to the Protégé during this reporting period (list Contract and Task Order Number).
  6. What other support did your company provide to the Protégé during this reporting period (i.e., new equipment, use of facilities, staff and/or assignment or loan of executive personnel to the Protégé, financing for the protégé’s training, etc.)?
  7. Identify teaming efforts with your Protégé on HHS, or other federal or private sector efforts? Describe the type of teaming (i.e., prime-subcontractor) and work to be performed.
Teaming Efforts (Contract/Task Order #)Estimated Dollar ValueMentor Roles and ResponsibilitiesProtégé Roles and Responsibilities

        

         

         

         

        

         

         

        

        

 

         

 

 

  1. Are there suggestions, recommendations, or changes you would like the HHS to consider, as an improvement to the Mentor-Protégé Program?
  2. Additional comments are welcomed:

Thank you! Your comments will help determine the effectiveness of this program.


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