Growth Accelerator Entrepreneurship Challenge Application Form
Email address *
Name of your Company *
Your answer
Contact Details
Your Website (URL)
Your answer
Your Facebook Page
Your answer
Your Twitter page or handle
Your answer
Company's LinkedIn page
Your answer
Company's Instagram page
Your answer
Company's YouTube Channel
Your answer
Company's Physical office location
Your answer
City / Town *
Your answer
Country *
APPLICANTS DETAILS
Your First Name *
Your answer
Your Surname *
Your answer
Your Job Title *
Your answer
Your Mobile Phone Number *
Your answer
Your Alternate Mobile Phone Number
Your answer
Your Email Address *
Your answer
Your Alternate Email Address
Your answer
Your Gender *
Your Age *
Highest Level of Education *
COMPANY SETUP
Which year did your company start operating? *
Your answer
Year of the company registration (documents of registration will be required for verification): *
Your answer
How is your company registered? *
What stage is your company in? *
What is your annual turnover?
BUSINESS DETAILS
What is your business pitch? (50 words) *
Your answer
What is your vision for the company? Talk about short term, medium term and long-term objectives. (100 words) *
Your answer
Why are you applying to the Growth Acceleration Entrepreneurship Challenge? (50 words) *
Your answer
What industry does your company primarily operate in? *
What other industry does your company primarily operate in?
What challenges/needs are your product(s) or service(s) addressing and how? (100 words) *
Your answer
Briefly describe the product(s) or service(s) that you are offering: (50 words) *
Your answer
What market segment(s) are you focusing on? *
Your answer
Briefly describe your business model: (50 words) *
Your answer
Describe your target customer(s): (100 words) *
Your answer
Who are your competitors? (offering same/similar/competing products or services) (50 words) *
Your answer
What differentiates you from your competitors or alternative products/services? (50 words) *
Your answer
What percentage of your revenue is generated from export?
Do you have the intellectual property rights for your products/services?
Is the intellectual property patented or registered?
GROWTH CHALLENGES
What are the 3 main challenges you are facing currently in respect to the growth of your business? *
Required
IMPACT
Is your (current or planned) product or service directly targeting low-income consumers
Which social impact does your business aim to create? Select up to three. *
Required
For each of the social impacts, explain in more detail the social impacts achieved so far in your business, e.g. nature of the impact, geographical reach, number of people impacted, etc (100 words)
Your answer
What is the main human development challenge that your business is addressing? *
If Other, please explain
Your answer
How does your business currently address Gender Equality?:
Your answer
How does your business currently address Human Rights?:
Your answer
REVENUE & FINANCE (Documents will be required for verification for some of the questions below)
Which year were you last audited? Indicate if your company has not been audited before. *
Your answer
How fast can we possibly have a hard copy of your audited accounts? *
Do you have management accounts for this year? *
What was your total sales (revenue) in USD in the past 12 months? *
Your answer
What is your targeted annual sales (revenue) in USD in 3 years from now? *
Your answer
Have you raised any external financing in the past 12 months? *
If YES to above question, what type(s) of financing did you raise?
If YES to above question, how much money (in USD) did you raise in the past 12 months?
Your answer
Are you seeking to raise external financing? *
if YES to above question, how much financing in USD are you seeking to raise?
Your answer
If YES to above question, what type(s) of financing did you raise?
What is the financing intended for? (what do you plan to do with the finances?)
ACHIEVEMENTS & GROWTH
Which three key milestones did you achieve in the past 6 months?
Key milestone 1 (Financial): *
Your answer
Key milestone 2 (Social): *
Your answer
Key milestone 3 (Operational): *
Your answer
Describe your growth plans and strategies for the next 24 months? (e.g. increase in staff/improving their skills, new products/changes to your offering, new machines, new markets/changes in your marketing strategy, improve supply chain, innovations or strategic partnerships, etc.) *
Your answer
TEAM & MOTIVATION
Describe the ownership structure of your company i.e. names of shareholders, number/percentage of shares owned by each shareholder: *
Your answer
Why did you start this company/What drove you to start the company? *
Your answer
Describe one major challenge you have experienced /are facing and how did you resolve it? What are you doing to resolve the challenge? (50 words)
Your answer
How many co-founders does your business have? Do *NOT* include “sleeping partners”/ non-active co-owners/director:
Your answer
Co-founder 1 First name and Surname (separately):
Your answer
Co-founder 2 First name and Surname (separately):
Your answer
Co-founder 3 First name and Surname (separately):
Your answer
Co-founder 4 First name and Surname (separately):
Your answer
Which statement is most true about you and your business:
Do you have a board of directors? *
Number of full time employees by end of last month. Do *NOT* include co-founders: *
Your answer
Number of part-time employees by end of last month:
Your answer
Number of casual workers by end of last month:
Your answer
Why do you want to join this programme?
Hope to gain financing and/or access to investors *
Hope to understand my business better, to make better decisions *
Hope to be mentored by experienced and successful business executives and entrepreneurs *
Hope to gain confidence in my business model and be better at selling my business *
Hope to get access to new customers and markets *
Hope to fellowship with other entrepreneurs *
Hope to become a better business leader *
.
Score these statements in terms of your agreement or disagreement:
We are open to sharing ownership of our business *
We are willing to share freely our business information with investors *
We are open to investors advising and criticising our business *
We are willing to give up some operational control to investors *
We are willing to reward investors in the same way we are financially rewarded *
Objectives
State at least 3 objectives you hope to achieve from participating in the Growth Accelerator Entrepreneur Challenge:
Objective 1: *
Your answer
Objective 2: *
Your answer
Objective 3: *
Your answer
Have you previously participated in any accelerator programmes?
If Yes to above question, which one(s)?
Your answer
OUTREACH
Who in your network of entrepreneurs would you recommend to participate in this programme? (Please share their contacts details):
(1) Entrepreneur's name, company name, mobile no. and email address
Your answer
(2) Entrepreneur's name, company name, mobile no. and email address
Your answer
(3) Entrepreneur's name, company name, mobile no. and email address
Your answer
Where did you first hear/learn about the Growth Accelerator Programme first? *
DATA SHARING
Do you consent to us sharing data from this application form with organisations/programmes offering similar opportunities? *
A copy of your responses will be emailed to the address you provided.
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