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1
Step 1
The Applicant
Name
Your full name
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Date of Birth
(DD/MM/YYYY)
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Phone Number
call
Email
A valid email
email
Role in Organization/ Enterprise
Your Position or Role at the Applying Enterprise
group
The Organization/ Enterprise
Organization/ Enterprize
Give a brief summary of the organization; its history, structure and ambitions
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Your Vision
Tell us about the problem you are trying to solve
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Your Mission
Describe how are you contributing towards solving this problem
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Your Beneficiaries
Who do you see benefiting from your efforts? Why will it be important to them?
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/
Evidence of Impact
How do you describe your impact and measure it? How many people has your organization served so far? Make sure that you provide specific and quantifiable evidence in response to these questions
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/
Is your Organization/ Enterprise Registred?
If, yes, then when and where?
Leadership Team
How many members are there on your team?
Please include full-timers, part-timers
Describe the role of each team member
Describe each member's previous startup experience
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Services, Products and /or Solutions
What sector/Industry does your Organization/ Enterprise fall under?
pick one!
Select An Option
Technology
Health
Energy
Media
Consumer Retail
Construction
Hospitality
Finance
Real Estate
Transportation
Education
What are your main services, products and/or solutions?
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/
Are your products/solutions digital or digitally-powered?
Select An Option
Yes
No
Select the specific tech verticals and innovation drivers that fit the description of your Organization/ Enterprize?
3D Printing
Adtech
Agriculture Tech
Artificial Intelligence and Machine Learning
Audio Tech
Autonomous Cars
Big Data
Blockchain
Clean Tech
Cryptocurrencies
Cybersecurity
Ecommerce
Edtech/ Cloud Education
Fintech
Govtech
Healthcare
Infrastructure
Internet of Things (IoT)
Life Sciences
Lifestyle of Health and Sustainability
Marketplace
Marketing tech
Mobile
Nanotechnology
Oncology
Regtech
Robotics and Drones
Virtual Reality and Augmented Reality
Wearables and Quantified Self
Other/ Please specify
Please Specify
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What is innovative about your services, products and/ or solutions?
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What is the stage of your product?
pick one!
Idea stage
Beta version
Minimum viable product/ Prototype
Fully-developed revenue product
Financial Position
Briefly describe your money-generating model
If you are a for-profit organization, what is your revenue generation model? If you are a non-profit organization, what is your source of cash flow
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/
What funding stage are you at?
pick one!
Pre-seed funding Stage
Seed funding Stage
Series (A) Funding Stage
Series (B) Funding Stage
What kind of support/mentorship are you looking for? and in what areas?
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How did you know about Entrepreneur in Residence?
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