Map 4 Impact - Social Enterprise Details
If you are an organization with multiple social enterprise branches or businesses, please contact us, and we can help get your enterprises on the map or if you are on the map and would like to update your details, or take yourself off the map, you can reach us at the email address below.

Contact: mapforimpact@gmail.com

Social Enterprise Name *
Your answer
ABN (Australian Business Number)
Your answer
Street address of the Social Enterprise (number, street, suburb) *
Your answer
Postcode of the location of the Social Enterprise
Your answer
Social Enterprise Website address
Your answer
Social Enterprise Email address
Your answer
Social Enterprise Phone number
Your answer
Key Contact Name *
Your answer
Key Contact Email Address
Your answer
How would you describe the industry that the enterprise is in?
Your answer
What is the social and/or environmental purpose of the enterprise? *
Your answer
Who are the target beneficiaries the enterprise intends to support?
Your answer
What products or services does the enterprise provide? *
Your answer
Does the enterprise re-invest profits or surpluses to support its social mission (including to grow the enterprise)?
Is the enterprise owned by another organisation?
If 'yes' please specify.
Your answer
Are there multiple branches of this enterprise
If 'yes' please specify
Your answer
Is the enterprise an Australian Disability Enterprise?
Is the enterprise an Indigenous owned organisation?
Any other comments?
Your answer
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
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service