2008 Social Entrepreneur Competition

The information below should be filled by a representative of the organization, ideally the founder, to be considered for the Social Entrepreneur of the Year award. In order to be eligible, your organization has to be based in one of the countries where the award is presented.

Fields marked with * are mandatory

Contact Details

Date of Application:

Day: * Month: * Year: *

Last Name of Candidate:

First Name:

How did you hear about this competition?:

Birth date:

Day: * Month: * Year: *

Organization:

Address:

City:

Mail Code:

State/Province:

Country:

Telephone:

Country Code: *

Area Code: *

Telephone *

Fax:

Country Code: *

Area Code: *

Fax *

E-mail Address:

Web-site:

A. Information on the Organization

A.1. Geographic area of activity of the organization:

A.2. Year organization was established:

A.3. Area of activity (check as many as apply): *

	Health
	Environment
	Enterprise Development
	Microfinance
	Technology
	Water / Sanitation
	Education
	Homelessness & Housing
	Communication / Media
	Rural Development
	Fair Trade
	Labor Conditions
	Other

A.4. Tell us about the organization. What problems does it seek to address and how? How is it legally constituted (i.e. for-profit, not-for profit)? (max. 150 words):

A.5. Describe the management team of the Organization (max. 100 words):

A.6. Indicate the number of *

Full-time staff
Part-time staff
Volunteers

B. Information on the Founder

B.1 Tell us about yourself/the founder of the organization. What inspired you/the Founder to spearhead the original idea? (max. 150 words):

B.2 Time commitment: How much of your time do you invest in this organization? *

	Full-time
	Part-time (indicate monthly percentage of time) %

C. Meeting the Criteria

Please mark the box you feel best reflects you / your organizations situation. Add comments you feel would be helpful.

1. Innovation

a) The Innovation is best described as the following (check as many as apply) *

	It is a new product
	It is a new service
	It is a new technology
	It is a new approach to an old problem
	Other (specify)

Comments:

b) To what extent has the initiative introduced new approaches or offered new solutions to societal problems? *

	Approach or solution is applied by other organizations in the country with slight variations
	Approach or solution is new to the area or this region of the world, but similar ones are in place or practiced elsewhere
	Approach or solution was unknown prior to the initiative, but the innovation represents only a minor departure from prior practice
	Approach or solution truly has discovered a unique way of using/ combining resources, has discovered new resources or services/ service delivery methods

Comments:

2. Reach and Scope

a) CURRENTLY, how widespread is the initiative? *

	Spans several communities in one state/department.
	Spans several states/departments of a country
	Spans most of the country
	Spans more than one country

Comments:

b) How many direct beneficiaries are therein total AT THIS TIME ? *

	Less than 5,000.
	Between 5,000 and 15,000.
	Between 15,000 and 50,000.
	Over 50,000.

Comments:

3. Direct Social Impact

a) To what extent has the initiative transformed established practices and systems? *

	The initiative provides a service to the community within the structures that exist
	The initiative is intended to change established practices and systems, but this is not yet evident
	Impact on established practices and systems is becoming evident
	Has entirely transformed established practices and/or systems

Comments:

b) How tangible are the results of the initiative to date? *

	Not proven yet whether or to what extent peoples� lives have been improved
	Results sufficient to surmise that people�s lives were improved, but documented evidence still limited or lacking in proof
	Rudimentary evidence shows tangible impact on people�s lives with supportive quantitative and qualitative documentation
	Evidence is convincing of significant tangible improvements in people�s lives, with substantial documentation

Comments:

4. Replicability

a) How far could the initiative be expanded from its original group of beneficiaries? *

	Application may be restricted largely to initial beneficiaries
	Could be expanded to adjacent communities
	Could be expanded to neighbouring states-/departments of the country and/or other countries
	Extends into other countries already

Comments:

b) To what extent can elements be adapted to other settings? *

	Potential for adaptation elsewhere is unclear
	Some or many elements of the initiative can be transferred and adapted elsewhere within the same environment
	Most aspects of the initiative can be transferred and adapted to other settings around the world
	Extends into other countries already

Comments:

5. Sustainability

a) Political *

	Changes in the political environment or legislation could readily undercut the initiative
	Changes in the political environment or legislation might undercut the initiative
	Changes in the political environment or legislation unlikely to undercut the initiative
	Initiative insulated or independent of political events and legislation

Comments:

b) Financial *

	The initiative has no outside funding and relies fully on non-paid volunteers
	The initiative is funded solely by charitable giving in he form of grants and donations
	The initiative generates a portion of its revenues through the sale of goods and services or membership fees
	Initiative is fully self-sufficient or assured as to funding

Comments:

c) What percentage of its budget does the organization generate through the sale of products, services or fees? *

	Between 0-20%
	Between 21-50%
	Between 51- 75%
	Between 76- 100%

Comments:

d) To what extent is the initiative leveraging mutually beneficial partnerships with companies, the public sector, or organizations of civil society? *

	The individual/ organization is a �lone ranger�
	Up to 2 partnerships (of a duration of at least 12 months) and receives some in-kind/ financial support
	3 to 6 long term partnerships (of over 12 months) with businesses, the public sector or civil society organizations
	Over 7 long term partnerships (of over 12 months) and have become an integral aspect of the activities of the organization

Comments:

6. Role Model/Leadership

a) How long have you been engaged in this organization/initiative? *

	Fairly recently (less than 2 years)
	Modest time (2-5 years)
	Seasoned (5-10 years)
	Career / life (over 10 years)

Comments:

b) How experienced were you for work in this field? *

	No previous involvement in such initiatives
	Some prior experience in this or other such fields (between 3 and 5 years)
	Wide experience in this and/or other complementary fields (5 to 10 years)
	Significant experience in this and/or other complementary field (over 10 years)

Comments: