Impact Hub Amsterdam presents...
... the 12th edition of the Business Model Challenge!

Great you are applying for the Business Model Challenge!

So as you can see, we're asking a lot of questions. Don't worry though, we have tried to work with multiple choice in most cases, which will save you time. You should reserve about 20 minutes to answer all the questions. Please note that some questions are (optional).

As a final note, we will treat your application confidentially and none of it will be shared outside of the program team.

Make sure this form is filled in before March 15th 2017. We'll come back to you to let you know if you are a suitable candidate for The Business Model Challenge.

-----------------------------------------------------------------------------------------------------------------------------------

N.B. Wil je dit formulier liever in het Nederlands invullen? Dat is geen probleem.

Primary Contact Information
What is your name?
Your answer
Which edition are you applying for?
What is your gender?
What is your date of birth?
MM
/
DD
/
YYYY
What is your email address?
Your answer
Wat is your mobile phone number?
Your answer
Where are you located?
City, Country
Your answer
Are you already an Impact Hub member?
Company information
General company information
What is the name of your venture?*
If selected we use this name on our website as well.
Your answer
What is your company's street address?
If you haven't registered your company yet, please fill in your personal address.
Your answer
What is the URL for your website / demo etc?
Your answer
When did you start your company? (date)
Your answer
When did you register your company at the chamber of commerce? (date or ''I haven’t registered yet'')
Your answer
In which stage do you consider your venture to be?
Why are you in this stage?
Your answer
Do you already have a business plan? If so, would you like to share it with us? (Y/N, email to: ilse.kwaaitaal@impacthub.net.)
Team
Please describe the core team of your venture
Team responsibilities - Please describe responsibilities of the management team of your venture at this moment. Use the following format: Name, Role (founder, management, shareholder), main tasks and responsibilities, commitment in hours per week, amount of money invested in the company (actual money, not in-kind contributions). Example: Alex Green, Founder, Marketing and sales, 20 hours, 0 euros
Your answer
Team experience - Please describe experience of the management team of your venture at this moment. Use the following format: Name, number of years of experience running a business, number of businesses run in total, number of businesses started in total, number of years of experience in management positions (round off to half a year). Example: Alex Green, 5 years, ran 1 business, started 1 business, 1.5 years.
Your answer
How long has the core team worked together as a team so far? (Number of years and months. Round your answer to the nearest month.)
Your answer
Not including the management team, how many additional employees do you have? (number of FTE)
Your answer
Please describe (1) why your team is equipped to take this venture to the next level (for example, prior experiences, individual skills, such as software development, design, finance etc.) and (2) what your team is currently lacking or how it can still be improved.
Your answer
Product or service offering
General product / service information
Please describe your product / service (What are you planning to sell, what is different / interesting / new about your business, who are your competitors, how are you different from these competitors, etc.)
Your answer
What is your target market?
Which of the following impact fields does your product contribute to?
What is the geographical focus of your venture?
Your answer
Performance indicators
Financial and impact ambitions
What is the most recent milestone of the business?
Think of new employees, first sale, investment and/or funding etc.
Your answer
How much revenue has your venture generated in its lifetime? (In Euros)
Your answer
How much revenue do you expect to generate the coming year? (in Euros)
Your answer
Number of paying customers? (in numbers)
Your answer
In case your users are not your paying customers, how many users do you have? (in numbers)
Your answer
Please describe the impact you hope to create and the scale you hope to reach.
Your answer
How are you currently, or how do you plan to measure your impact?
Max 500 characters
Your answer
Learning goals
Learning goals for the BMC program
Who from the team will participate in the BMC program?
Your answer
What would you like to learn from the business model challenge?
Your answer
Please confirm the following:
To be eligible for the program, you need to confirm all items. If one or more of them raise issues, please contact our team at [insert email address].
How did you find out about our program?
Required
Can we share your contact details with relevant people/organizations to approach you for business or investment opportunities?
(no promo/spam)
Who would you like to invite to your final pitch?
Your answer
What other ventures/entrepreneurs would you recommend to also apply for the program?
Indicate your friend's name and email address and we'll send an invitation on behalf of you!
Your answer
If selected, we want to screen you on our website, can you please send a picture to ilse.kwaaitaal@impacthub.net?
Thanks a lot!
If selected, what name can we use on your invoice?
Your answer
Click "submit" to send in your application.
Submit
Never submit passwords through Google Forms.
This form was created inside of Impact Hub Amsterdam. Report Abuse - Terms of Service - Additional Terms