EmailMe Form - Global Catalyst Initiative

Global Catalyst Initiative
Global Agents is searching for early stage, market-oriented projects seeking to address global poverty. Our goal is to help take promising projects from pilot to proof of concept, improving their models and dramatically increasing their ability to garner further support or investment.

Apply to be one of two groundbreaking projects to receive $40,000 in funding, mentorship, and access to key advisors.

Please fill out the following, and we'll be in touch if we have any follow up questions - good luck!

Organization Name *

Contact Person's Name *

Prefix

First *

Last *

Suffix

Email *

Address *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Phone Number *

###

####

Website *

1) Is your organization registered? *

Yes

If you are not registered organization but are sponsored by one please include details in the section below.

a) If yes, please indicate the following:
Registration date

Where is your organization registered?

What is your organization's legal form?

Please indicate non-profit, charity, for-profit, or other legal status. If you are registered in multiple locations (ie. US and Kenya, Canada and Sri Lanka, etc.), please indicate.

b) If no, please indicate registration plans and progress.

*Please note – Organizations must be less than 2 years old, and have an annual operating budget under $150,000 to be eligible.

New projects from established organizations are not eligible, though independent projects being legally sponsored by a larger organization may qualify.

2) Venture description

a) Clearly state your vision and mission *

Maximum 150 words

b) Date commenced *

c) Primary location *

d) Please provide a brief description of the key components of your venture and the unique value it creates for society *

Maximum 350 words

3) Have you tested or piloted the idea in any way? Please describe any pilot or test results, and lessons learned thus far *

Maximum 350 words.
Projects must be passed the idea stage to be eligible for funding.

4) Explain how the project has engaged local community members *

Maximum 350 words.

4) How do you intend to measure the effectiveness of the project? Please identify key short and long term success indicators *

Maximum 250 words.

6) Briefly tell us about the people behind this – who are we investing in?

a. Upload a resume for each key individual. *

7) Financials

a) Please upload a detailed budget for the current year. *

Indicate any existing sources of funding, shortfalls in your projected budget, and highlight exactly what you believe GCI funding could support.

b) Please upload financials for the previous two years, or for the duration of the organization's existence, if applicable.

8) Do you intend to derive all or part of future funding from self-generated revenue? Please explain. *

Maximum 250 words.
*Projects with a long-term revenue model for self-sufficiency and growth are preferred.

9) Have you thought about potential future funders or investors? Please explain. *

Maximum 150 words.

10) Please indicate in USD how much funding is being applied for and when you need the funding by. *

*GCI funding usually begins no earlier than January 1st of the following year, but this may be advanced on request in special circumstances.

Anything else you’d like to add? *

Maximum 250 words.

For further questions or clarifications, please email: pamy.teja@globalafc.org

www.globalafc.org

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