NYWSE Incubator: Empowering Women Social Entrepreneurs Entrepreneur Application
January-June 2009 Bio Data/Personal Description 1) Full legal name (first, middle, last) 2) Name you prefer to be called 3) Address (street, apt, city, state, zip code) 4) E-mail 5) Home phone 6) Cell phone 7) Date of birth 8) Highest degree earned/where 9) Previous experience in diverse SE fields 10) Interests/hobbies 11) Are you willing and able to commit to spend 10-15 hours per week on SE? 12) Do you have a mentor/apprentice w/ whom you want to work? (yes/no) SE Description 13) 3-4 sentence description of SE
14) Company/organization name, if exists 15) Service/produce description
16) Target market/clients (qualitative and quantitative description) 17) Social impact to be created: # of people to benefit - short term 18) Social impact to be created: # of people to benefit - long term p. 1
NYWSE Incubator: Empowering Women Social Entrepreneurs Entrepreneur Application
January-June 2009 19) Estimated SE income goals: # clients x income/client = gross revenues 20) Anticipated status: for profit or non-profit 21) Related experience in this SE field 22) Work done/accomplishments to date on SE 23) Barriers encountered to launching SE to date (in priority order) 24) Strengths vis a vis SE 25) Weaknesses vis a vis SE 26) Other elements needed to realize SE 27) Do you have family, partner, or community support for project? 28) Specific, measurable result will be produced at end of 6 month program (describe in full): e.g. provide services to first clients (#), earn X income, obtain financing (debt/equity) for business, create and launch new product/service, expand into a new location, write full business plan
29) Rough implementation timeline to achieve SE specific measurable breakthrough result (at least monthly goals). Will be finalized in program. Month 1: Month 2: Month 3: Month 4: Month 5: Month 6:
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NYWSE Incubator: Empowering Women Social Entrepreneurs Entrepreneur Application
January-June 2009 Supporting Documents 30) Resume attached? yes/no 31) Personal statement of motivation for participation attached? yes/no (1 pg max ) 32) $25 application fee attached? yes/no
Application fee goes toward participation fee if accepted.
Please submit applications to allison@allisonlynch.com. Apps can be completed electronically or by hand then scanned. THANK YOU!! Please name files: Last name-Entrepreneur App-Date, Last name-Entrepreneur Resume-Date, Last name-Entrepreneur Statement-Date Please make checks payable to New York Women Social Entrepreneurs and mail to: NYWSE c/o Allison Lynch, 114-20 Queens Boulevard, #E1, Forest Hills, NY 11375
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