Map 4 Impact - Social Enterprise Details
If you would like to apply for your organisation to be put on the map, please fill out the below form. We will screen your application at our next quarterly review and automatically add you to the map if your application is successful. Unfortunately, we won’t be able to get in contact with you to share the outcome of your application because of the high number of requests we receive. We appreciate your support of Map for Impact.

If you have any questions, please contact mapforimpact@swin.edu.au

Sign in to Google to save your progress. Learn more
Social Enterprise name *
ABN (Australian Business Number)
Street address of the Social Enterprise (number, street, suburb) *
Postcode of the location of the Social Enterprise
Social Enterprise website address
Social Enterprise email address
Social Enterprise phone number
If your Social Enterprise has a Facebook page, please provide a link
If your Social Enterprise has a Twitter account, please provide a link
Key Contact - first name *
Key Contact - surname *
Key Contact - email address
How would you describe the industry that the enterprise is in?
What is the social and/or environmental purpose of the enterprise? *
Who are the main groups that benefit from your enterprise? *
What products or services does your enterprise sell? *
Does the enterprise re-invest profits or surpluses to support its social mission (including to grow the enterprise)?
Clear selection
Is the enterprise owned by another organisation?
Clear selection
If 'yes' please specify.
Are there multiple branches of this enterprise?
Clear selection
If 'yes' please specify
Is the enterprise an Australian Disability Enterprise?
Clear selection
Is the enterprise an Indigenous owned organisation?
Clear selection
Any other comments?
The fine print
Please note that the data you provide will be used to inform the ‘Map 4 Impact’ project to locate social enterprises on a publicly available online map. This map will be available to the public to promote the visibility of social enterprises across Victoria.
Only organisational data will be made public, any personal data will not be made public, including personal contact information.
The data you provide will be collected by the Centre for Social Impact, Swinburne (CSI-S) and shared with the Victorian government to inform its Social Enterprise Strategy (2017). Your data may also be used to promote opportunities relevant for Victorian social enterprises, such as funding, networking, business development and research opportunities.

By providing data, you consent for the details you provide to be used by CSI-S for the purposes described above.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms