SOCAP17 - Social Entrepreneur Application

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Welcome to the SOCAP17 Scholarship Application for Social Entrepreneurs

This application form is for the SOCAP17 Entrepreneur Scholarship.

International applicants should apply by June 1, for early consideration and notification by July 5. For all other applicants, the deadline is June 30, 2017. All selected scholar entrepreneurs will be notified by the beginning of August.

For more information, please visit: http://socap17.socialcapitalmarkets.net/get-involved/social-entrepreneur-scholarship/

Note that SOCAP focuses on for-profit models. We do select a limited number of non-profits into our scholarship program. Some non-profits may not receive an appropriate investor meet-up at the conference.

Contact Information

Name*

First Name*

Last Name*

Email*

Nationality*

If given a scholarship, will you need an invitation letter in order to obtain a visa?*

Country of Residence*

State*

Gender*

Name of the Venture*

Website*

Twitter Handle

Address of your venture*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

How did you hear about the SOCAP scholarship?

SOCAP website SOCAP newsletter Twitter/Facebook Friend/Fellow Entrepreneur

Other: Other Value

We're just curious!

Have you participated in any other Impact Hub or SOCAP programs?*

Impact Hub Member SOCAP Social Entrepreneur Scholarship SOCAP Volunteer SOCAP Attendee SOCAP Panelist None

Which Impact Hub are you a member of? (if applicable)

Have you or are you participating in an accelerator or incubator program?*

Yes No

Which one? (if applicable)

Have you participated in any other social entrepreneurial programs that you would like us to be aware of?

Venture Information

This set of questions will be most carefully considered when selecting SOCAP scholarships. Please make sure your answers are clear, direct, and communicate the impact of your venture!

What is your venture’s organizational form?

In what year was your venture founded?*

What is the stage of your venture?*

Please select the option that best describes the stage of development of your product or service.*

Is your company pre or post revenue? (Has it made money?)*

How much capital have you raised to date? (Provide in USD)*

Are you currently raising capital?*

Yes No

How much are you seeking to raise? (Provide in USD)*

Where is the primary geographic focus of your venture?*

Africa Asia & Oceania Western Europe Eastern Europe/Russia Central and South America Middle East North America Global Focus

What is your target geographic market?*

What is your venture's primary sector?

Agriculture Community Development Economic Development Education Energy Environment Financial Products & Services Health Housing Media Technology Water

Other: Other Value

Does your venture affect other sectors? (choose up to 2)

Agriculture Community Development Economic Development Education Energy Environment Financial Products & Services Health Housing Media Technology Water

Other: Other Value

Please describe your venture: (max 50 words)*

What is the problem you are solving and why is this important? (max. 150 words)*

What is your solution and business model? (max 200 words)*

Who are your top competitors or other similar companies (if any) working in this space? How are you different from them?* (max 200 words)*

Compare with direct or indirect competitors to differentiate your business, if appropriate.

Please describe who your customers are and how you know they want your product? (max. 150 words)*

Please describe your company's current financial situation. (Include revenue generated to date, type of capital raised and amount, projected revenue and fundraising objectives for 2016) (max. 200 words)*

Please provide a short bio for each key team member. If available, please include a link to each team member's LinkedIn profile page.*

Please describe the impact your company will have or is having, the way that you measure your impact, and the scale you plan to reach? (max. 150 words)*

Are there key partnerships or collaborations that your organizations has secured? (max. 150 words)*

Please describe how your product or service will benefit from participating at SOCAP? (max. 150 words)*

How many full-time people are on your team?*

How many full-time people on your team are paid?*

How many part-time people are on your team?*

How many part-time people on your team are paid?*

Marketing Materials

If you are selected for a scholarship, this information may be used for online and offline marketing communication.

Logo of your venture

No File Chosen

File uploads may not work on some mobile devices.

We currently can not upload logos. We will let you know if we need your logo.

A profile picture of you

No File Chosen

File uploads may not work on some mobile devices.

We currently can not upload pictures. We will let you know if we need your picture.

I understand that the SOCAP17 scholarship does not cover travel costs and that I will need to cover my roundtrip travel expenses to San Francisco if I am selected for a social entrepreneur scholarship to SOCAP17.*

I agree

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