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Markets: Supplier Diversity Program
Supplier Profile Form - Step 1
The first step toward potential teaming opportunities with Pearson Government Solutions is to complete the profile form below. We encourage all U.S.-based suppliers to complete and submit the form. Once we receive your submittal, we will review your information and contact your firm should an appropriate teaming opportunity develop. Step 1: Complete the form below and click Submit. You will be given an opportunity to review your submittal prior to "Step 2: Confirm." (If you wish to print the form and manually compile your responses prior to completing this form electronically, please use this PDF version of the form.)
The first step toward potential teaming opportunities with Pearson Government Solutions is to complete the profile form below. We encourage all U.S.-based suppliers to complete and submit the form. Once we receive your submittal, we will review your information and contact your firm should an appropriate teaming opportunity develop.
Step 1: Complete the form below and click Submit. You will be given an opportunity to review your submittal prior to "Step 2: Confirm." (If you wish to print the form and manually compile your responses prior to completing this form electronically, please use this PDF version of the form.)
Company Contact Information
Company Name: (required)
Parent Company Name: (if different)
Street Address 1: (required)
Street Address 2: (optional)
City: (required)
State: (required) Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP Code: (required)
Company Website Address: (required)
State of Incorporation: (required) Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Primary Contact's First Name: (required)
Primary Contact's Last Name: (required)
Primary Contact's Title: (required)
Contact's Phone (10 digits no spaces): (required)
Primary Contact's E-mail: (required)
Contact's FAX (10 digits no spaces): (required)
Tax ID Number (##-#######): (required)
DUNS Number (9 digits no spaces): (required)
Business Information
Are you registered in the Central Contractor Registry? (required) Select One Yes No If you are not registered, we highly recommend that you take the time to do so: www.ccr.gov
Number of Employees: (required) Select One 1-50 51-100 101-300 301-500 501-1000 over 1000
Annual Gross Revenue: (required)
Business Classification: (required) Select One Large Business Small Business Foreign-Owned Non-Profit Other
Business Information - Small Business
Business Ownership Type: (required) To select more than one type, press CTRL+click on each desired item. Select all that apply Small Disadvantaged Business (SBA Certified) 8(a) Woman-owned Small Business HUBZone (SBA Certified) Veteran-owned Small Business Service Disabled Veteran Owned Small Business Historically Black College or University Minority Institution JWOD (Javits-Wagner-O'Day) Non-Profit Agency Small, Minority-Owned Business Other Small Business Large Business Non-Profit Educational Institution Non-Profit Hospital Other Non-Profit Organization State/Local Government - Education State/Local Government - Hospital Other State/Local Government Foreign Contractor
Small Business Ownership Type Descriptions
If 8(a) is selected, enter graduation date (MM/DD/YYYY):
If HUBZone SBA Certified is selected, enter certification date (MM/DD/YYYY):
If Small Disadvantaged Business (SBA Certified) is selected, enter certification date (MM/DD/YYYY):
NAICS Codes (optional) (click to view codes on census.gov)
Business Capabilities
Prior Experience: (required)To select more than one, press CTRL+click on each desired item. Select all that apply Air Force, Department of Agriculture, Department of Army, Department of Central Intelligence Agency Commerce, Department of Commercial Commercial Health Education, Department of Energy, Department of Environmental Protection Agency Federal Aviation Administration Federal Communication Commission Federal Deposit Insurance Corporation General Services Administration Health and Human Services, Department of Homeland Security, Department of Housing and Urban Development, Department of Interior, Department of Justice, Department of Labor, Department of Local Governments Marines, Department of National Aeronautics and Space Administration National Science Foundation National Security Agency Nuclear Regulatory Commission Office of Personnel Management Securities and Exchange Commission Small Business Administration Social Security Administration State, Department of State Governments Tennesse Valley Authority Transportation, Department of Treasury, Department of US Postal Service Veterans Affairs, Department of Other (please list below)
Key Past Performance/Clients
Past Performance 1 (required):
Past Performance 2:
Past Performance 3:
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