Technical Assistance: Leveraged Projects Assistance Request Form

Please fill in the Leveraged Projects Assistance Request Form and click the submit button.

If you do not receive confirmation within two business days that your request has been received, please contact Sharon Evans at 505-845-9671.

An asterisk (*) indicates a required field.

Company Name *

First Name *

Last Name *

Title

Phone *

Fax

Address

City

County

State

Zip/Postal Code

My company is located in New Mexico
Yes No

My company is a small business
(Per U.S. Small Business Administration guidelines)
Yes No

My company is a for-profit business
Yes No

My business pays gross receipts taxes to the State of New Mexico
Yes No

My company is U.S. owned and operated
(Not foreign owned or controlled)
Yes No

Is your company a subsidiary?
Yes No

Leveraged Project Proposal Title, Description, and LANL/SNL Contacts *:

Do you have a laboratory preference for this assistance request?
No Preference
LANL
SNL