NASA Space Request Form Δ Step 1 of 6 16% Review Terms Responses to this form are limited to four classes: (1) “United States Commercial Providers,” as defined in 51 U.S.C. § 50101(7), (2) U.S. Federal or State government entities, (3) Non-profit entities formed under the law of the U.S., or (4) “Institutions of Higher Education,” as defined in 20 USC § 1001. The following persons (including entities) are ineligible to be a Proposer or otherwise participate in the project (including as a contractor, subcontractor, or professional): (a) Any person/entity that has been debarred or suspended from doing business with the Federal government. (b) Any person/entity or its partners, members, or principal stockholders listed on any non-procurement or reciprocal lists on the most current “System for Award Management” published by the U.S. General Services Administration at www.sam.gov, as updated from time to time, or any replacement thereof. (c) Any person or entity or its partners, members, directors, officers, or principal stockholders that is included in the most current “Country Reports on Terrorism” report, issued by the Secretary of State in compliance with 22 U.S.C. § 2656f(a), available from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402 and at https://www.state.gov/country-reports-on- terrorism-2/; or (d) Any person or entity or its partners, members, directors, officers, or principal stockholders that is, or is acting on behalf of, a department, agency, or instrumentality of the government of the People’s Republic of China or any governmental subdivision thereof, or any company, university, or similar institution incorporated under the laws of the People’s Republic of China; For purposes of this, the term “principal stockholder” shall mean any person who is directly or indirectly the beneficial owner (as defined for purposes of Rule 13d-3 of the Securities Exchange Act of 1934, as amended, and promulgated by the Securities and Exchange Commission) of more than five percent (5%) of the outstanding stock or other equity of the entity in question (e) Any person or entity or its partners, members. directors, officers, or principal stockholders subject to a criminal indictment or information for a felony in any court in the United States.; or (f) Any other person or entity who is prohibited from entering into contracts with the US Government.You Must be at least 18 years old.(Required) By selecting this checkbox you confirm that you meet this requirement and accept the above terms Tell Us About YourselfName(Required) First Last Email(Required) Primary Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Tell Us About Your Company or OrganizationOrganizational Type(Required)U.S. Owned Small Business Under 500 EmployeesU.S. Owned Large Business More Than 500 EmployeesU.S State/Local GovernmentU.S. Academia or Non-ProfitU.S. Federal Government AgencyForeign Entity BusinessForeign Entity Academia or Non-ProfitForeign Entity GovernmentIndependent Researcher/IndividualPlease indicate the type of company / organization that you represent as part of this request. Tell Us About Your Company or OrganizationCompany / Organization Name(Required)Enter the name of the company / organization that you represent.Role / Title(Required)Enter the role or title you hold for your company / organizationAddress(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Website(Required) Unique Entity Identifier (UEI)12-character alphanumeric identifier issued through the System for Award Management (SAM) website for tracking federal grant dollars. Enter the UEI for the company / organization that you represent.Optional Information to Expedite ReviewProviding this information is optional. If included, it helps NASA validate organizational details more efficiently later in the process and may reduce follow-up requests if your proposal moves forward.HQ Country of OriginAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsSelect the country where your company / organization is legally headquartered.Annual Revenue / Budget Less than $250,000 $250,000 – $1 million $1 million – $10 million $10 million – $100 million $100 million – $500 million Over $500 million Enter the annual financial size of your company/organization.Size 1 – 49 employees 50 – 500 employees 501 – 1,000 employees 1,001 – 10,000 employees $100 million – $500 million 10,001+ employees Select the personnel size of your company / organization.Products / Service Lines Accommodation and Food Services Administrative and Support Services Aerospace and Defense Agriculture, Forestry, Fishing, and Hunting Arts, Entertainment, and Recreation Automotive Industry Chemicals Manufacturing Construction Education Services Environmental Services Finance and Insurance Food Manufacturing Healthcare and Social Assistance Information Technology (IT) Insurance and Risk Management Logistics and Supply Chain Management Manufacturing Media and Publishing Mining, Quarrying, and Oil and Gas Extraction Pharmaceuticals and Biotechnology Professional, Scientific, and Technical Services Public Administration Real Estate and Rental & Leasing Retail Trade Semiconductors and Electronics Telecommunications Utilities Wholesale Trade Other Select all product or service areas your company / organization actively provides.If Other, please specifyIf you selected Other in the Products / Service Lines field, describe here. Tell Us About Your Company or OganizationCompany / Organization Name(Required)Enter the name of the company / organization that you represent.Role / Title(Required)Enter the role or title you hold for your company / organizationWebsite(Required) Enter the website URL for your company / organization. Enter ‘N/A’ if none exists.Optional Information to Expedite ReviewProviding this information is optional. If included, it helps NASA validate organizational details more efficiently later in the process and may reduce follow-up requests if your proposal moves forward.HQ Country of OriginAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsSelect the country where your company / organization is legally headquartered.Government Focus Area (select all that apply) Agriculture and Food Safety Defense and Security Earth and Environmental Sciences Economic Development and Trade Education and Workforce Development Emergency Management and Disaster Response Energy and Utilities Health and Medical Research Information Technology and Communications Regulatory Functions Scientific Research and Development Space and Aeronautics Agencies Select all focus areas aligned to your agency’s mission and operational scope. Request DetailsWhich NASA Centers and Facilities are you Interested In?(Required) Ames Research Center (ARC) Armstrong Flight Research Center (AFRC) Glenn Research Center (GRC) Goddard Space Flight Center (GSFC) Goddard Institute for Space Studies (GISS) Jet Propulsion Lab (JPL) Johnson Space Center (JSC) Katherine Johnson IV&V Facility Kennedy Space Center (KSC) Langley Research Center (LaRC) Marshall Space Flight Center (MSFC) Michoud Assembly Facility NASA Engineering and Safety Center NASA Headquarters (HQ) NASA Safety Center NASA Shared Services Center (NSSC) Neil Armstrong Test Facility Stennis Space Center (SSC) Stennis Space Center (SSC) Wallops Flight Facility White Sands Test Facility I don’t have a preference Select all that apply.Is this request in support of an existing NASA Mission(Required)YesNoSelect Yes or NoMission Alignment Description(Required)Provide brief explanation on how this request aligns to a NASA Mission. This field is limited to 500 characters.Identify the available properties that you are interested in(Required)Identify specific facility(s) from the link below. This filed is limited to 500 characters. Identify specific facility(s) from this link: View Listings of Properties . Unlisted Property(Required)Specify real estate requested. Include size, type, facility capabilities. This filed is limited to 500 characters. Occupancy Term(Required)Specify how long would you like to occupy the requested space. This filed is limited to 500 characters. Existing Agreements or Contracts(Required)List any existing contracts or agreements with NASA related to this request. This filed is limited to 500 characters. Support(Required)Identify if you will require utilities or other support services. This filed is limited to 500 characters. Additional InformationYou may optionally add any additional information related to this request. This filed is limited to 500 characters.
