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Cybersecurity Interest Registration
Data Elements:
cmmc-register-form.aspx
Company Name *
Address *
Key Contact *
Key Contact Title *
Key Contact Email *
Key Contact Phone *
Industry *
Number of Employees company-wide *
Number of Employees in Washington State *
Are you now, or do you intend to become a supplier in the Washington State Department of Defense (DoD) supply chain?
--Select One--
Yes
No
Maybe
If yes, anticipated CMMC Level (Its ok If you don't know) *
--Select One--
CMMC Level 1
CMMC Level 2
CMMC Level 3
CMMC Level 4
CMMC Level 5
I do not know
What is your motivation to seek assistance with cybersecurity?
--Select One--
Comply with DoD/CMMC requirements
Comply with other emerging cybersecurity requirements
Improve risk management profile
Other
How do you manage your IT services?
--Select One--
In house IT staff
Outside managed service provider
Other (fill in)
Has your company worked to be compliant with NIST 800-171 or other cybersecurity standards
--Select One--
Yes
No
If yes, please explain
Optional: Is your company ITAR registered
--Select One--
Yes
No
Unknown
Were you referred to register your interest? If yes, who referred you?
--Select One--
Impact Washington
Pacific Northwest Defense Coalition (PNDC)
Washington Procurement Technical Assistance Center (PTAC)
Other (fill in below)
Other referral:
Optional: Please share any additional Information on your organization cybersecurity maturity. (please do not share specific technology or confidential Information) *
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