Become Third Party Provider

BECOME A THIRD-PARTY PROVIDER

The GENEDGE Operations Team develops relevant practice areas and service offerings that address the needs of Virginia’s manufacturing, industry and technology companies. As we develop new ways to address client needs, we continue to build and leverage partnerships across Virginia. Additionally, we continue to form relationships with premier, third-party independent providers who deliver the right resources, at the right time to our clients.

Registering through our online application is the first step to becoming a GENEDGE Third-Party Provider. Once your application is reviewed and approved, Third-Party Providers are then eligible to be considered and selected for future projects with the GENEDGE Growth Manager and Practice Manager teams.

Please take a few moments to read Important Facts About Being a GENEDGE ALLIANCE Third Party Provider and then connect with us today to start the process of joining the GENEDGE team as a Third-Party Provider!

We look forward to receiving your completed online application and to the possibility of working with you!

Please complete this form to be considered as a GENEDGE Alliance Third-Party Provider. Please note that applications will only be considered through this secure website submission. The application requests information about your areas of expertise, industry focus, general qualifications, and at least two references that we may contact about consulting work you have conducted in the past.

We look forward to receiving your completed online application and to the possibility of working with you!

Primary Contact Name

First Last

Primary Contact Title

Secondary Contact Name

First Last

Secondary Contact Title

Organization

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

E-Mail Address

URL Address

Primary Phone

Primary Fax

Secondary Phone

Secondary Fax

Is your organization a…

If 'Other' please specify

Please indicate the number of people your organization employs full time.

Are you a Certified Small Business?

Yes

Minority Business Enterprise Information

Are you eVA registered?

Yes

eVA Information

Do you have an active Security Clearance?

Yes

If you answered 'Yes' to the previous question, what level?

Active Security Clearance Expiration date

Do you have professional liability insurance or the equivalent?

Yes

Liability amount $

If yes, please indicate the source of this insurance and its expiration date.

Professional Liability Insurance Source

Professional Liability Insurance Expiration Date

Please indicate the DAILY rate (or a range) that you normally charge clients for contract work.

Please indicate the geographic areas of Virginia in which you are willing to work.

Optional ~ Please provide a descriptive summary of your expertise and capabilities.

Please list any relevant and active memberships, certifications, licenses, awards, and other notable distinctions.

Please select the one general category that best describes the services your organization most often provides to manufacturers.

Expertise Code Ranking

Expertise Code Rank #1

Expertise Code Rank #2

Expertise Code Rank #3

Expertise Code Rank #4

Industry Focus Code

Expertise Code Rank #1

Expertise Code Rank #2

Expertise Code Rank #3

Expertise Code Rank #4

Please indicate how many years your organization has provided consulting services.

Please indicate how many years of industry experience your organization has.

Please indicate how many different clients you've served as a consultant in the past 2 years.

Please provide at least three references who we may contact concerning projects for which your organization served as a consultant. Please list references with projects that are as similar as possible to those you anticipate conducting through GENEDGE ALLIANCE.

Reference 1

IMPORTANT – Your application will not be processed unless two or more references are provided.

Reference 1 Title

First Last

Reference 1 Title

Reference 1 Organization

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Reference 1 Project Start Date

Reference 1 Project End Date

Reference 1 Project Description

Reference 2

Name

First Last

Reference 2 Title

Reference 2 Organization

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Phone

Project Start Date

Project End Date

Reference 2 Project Description

Reference 2

Name

First Last

Untitled

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Untitled

Phone

Date

Untitled

How did you first hear about GENEDGE ALLIANCE?

I have read and agree to the Important Facts About Being a GENEDGE ALLIANCE Third Party Provider

Yes

Read the important facts here.

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