Software Usage Agreement Questionnaire
This questionnaire is not a software usage agreement (SUA). An SUA is the legal document needed to transfer software. This form collects the information needed to prepare an SUA between your company/you and NASA.
(
*
indicates required field)
Date of Request:
*
Case Number:
*
Software Title Requested:
*
To whom will the software be delivered?
Full Legal Name (Including Middle Name)
(Must be at least 18 years of age):
*
Job Title:
*
Company/University Name:
*
Select One
Individual
College/University
Government Contractor
NASA
Other
Address
*
Is this a U.S. owned company?:
*
Yes
No
City:
*
State:
*
Zip Code
*
Work Phone:
*
Email:
*
Country of Citizenship:
*
Confirm Email:
*
Are you a Civil Servant?:
*
If Yes, List Agency Name:
*
Yes
No
Will there be other users of the software?
If Yes, Indicate which users will have access to the software:
Yes
No
Civil Servants Only
Contractors Only
Employees Only
Both Civil Servants and Contractors (Civil Servant Request)
Students
Will this software be used for Government Contract, Grant, Cooperative Agreement, or Space Act Agreement?
Yes
No
If Yes, List Agency Name:
*
If Yes, Please provide the following information:
Contracting Federal Agency:
*
Contract/Grant/Agreement Title:
*
Contract/Grant/Agreement Number:
*
Contract/Grant/Agreement End Date:
*
Do you plan to use the software in-house only?
Yes
No
Briefly explain the purpose for which the software will be used:
*
Please provide the following information for the person who has company signature authority for this transfer:
Same person identified above:
*
Yes
No
Full Name:
*
Title:
*
Address:
*
City:
*
State:
*
Zip Code:
*
Work Phone:
*
Email:
*
Please enter the following characters into the text box below before clicking the Submit Request button.
Submit Request
