We strongly encourage all potential candidates to carefully read our selection criteria before completing an application. Please note that government/public sector personnel, research institutions,

We strongly encourage all potential candidates to carefully read our selection criteria before completing an application. Please note that government/public sector personnel, research institutions, and foundations that provide financial or technical support to social enterprises will not be considered.

This information will be treated confidentially and used only for the purpose of evaluation for the Schwab Foundation network. If you have completed the Social Reporting Standard (SRS) (or a similarly comprehensive reporting standard) within the last 12 months, you may submit the SRS in place of this application.

IMPORTANT - The following documents must be submitted along with the application form:

· An updated copy of the applicant’s CV or resume

· Financial statements (income statements and balance sheets) for the last 3 years

· A copy of the most recent annual report

· Any available 3^rd party evaluation of your organization

· An organization chart or staffing chart with reporting lines

· Links to videos of recent public talks you have given, or current articles or blogs you may have written

· E-mail addresses of two references. Indicate their name, title, and organization, as well as a brief one-line description of the nature of your professional relationship (ideally your references can testify directly to your organization's activities and impact, so a funder, government partner, or third party expert would be ideal).

1. Date of Application (DD/MM/YY):

2. Social Enterprise Name:

3. Year Established:

4. Address of Headquarter Office:

5. Other Offices (City, Country):

6. Website:

7. Legal form of your organization (not-for-profit organization, private company, public company, etc.):

8. Sector(s) (i.e. microfinance, health, education, energy):

9. Geographic area of activity of the Organization

1. Please describe the functions of your supervisory body (board) and list the members. Are members compensated? How often does the supervisory body meet?

2. Please list your senior management team and their respective positions (i.e. top 3-4 staff).

3. What is the ratio between the highest paid full-time employee and the lowest paid full-time employee in your organization? Feel free to provide additional context for this ratio.

4. Who are your top three financial supporters or investors and what percentage of your grants or equity do they each constitute? If you have owners or shareholders, explain their voting rights.

1. Are your financial statements audited?

2. What are your main revenue streams and what percentage of your revenues do they each constitute?

3. What fees do you charge for your activities, products, and/or services?

Please provide the following data (financials in either USD or EUR).

Select currency EUR USD	2016 (estimate)	2015 (estimate)	2014 (actual)	2013 (actual)	2012 (actual)
Earned Income
Grants
Government Support
Total Revenue
Total Costs
Profit (Loss)
Current Assets
Current Liabilities
Total Assets
Debt
Equity
Number Direct Beneficiaries/Clients
Number Indirect Beneficiaries/Clients
Number Full Time Paid Employees
Number Volunteers

1. Applicant (Founder / Chief Executive) Name:

2. How much of your time do you invest in this organization:

3. Nationality:

4. Birth Date (DD/MM/YY):

5. Telephone:

6. Mobile Phone:

7. E-mail Address:

8. Personal Assistant’s E-mail Address:

9. Languages

	Mother Tongue	Converse with Fluency	Converse with Difficulty	Not at all
English
Other:
Other:
Other:

10. Please list the most recent prizes you and/or your organization have been awarded.

11. What are your motivations for joining the Schwab Foundation network? As a community member, a) How do you think you would benefit? b) How would you like to contribute to your peers?

1. Problem statement

Describe the current social or environmental issue(s) that your organization is trying to solve. Wherever possible, include detailed information on the target: statistics, figures, and facts. What are traditional responses to this problem? Why are they falling short?

2. Theory of change

We define “theory of change” as the intended social (or environmental) outcome you are trying to bring about and how your model or intervention achieves those outcomes. What is your theory of change? In other words, “how” is your model creating change?

1. Please describe the nature of any strategic partnerships you have (beyond purely funding relationships). Explain in concrete, specific terms how each partnership contributes to your organization’s social impact (i.e. companies, government, international organizations, NGOs, academic institutions, financiers, foundations, etc.).

1. In the grid below, share with us evidence of your organization’s current impact and expected future impact. Please describe in detail the demographics and size of the population(s) you impact and include indicators that you use to measure impact on each stakeholder segment.

	Evidence of Current Impact	Expected Future Impact
Direct (on beneficiaries and clients)	· i.e.: Number of students enrolled
Indirect (on other stakeholders)	· i.e.: estimated savings for the government

2. How do you collect this data (tracking sales, anonymous surveys, third party evaluations, etc.)?

1. Reflecting on your problem statement, please describe your vision of what your organization’s innovation looks like at scale.

2. Please describe your long-term strategic priorities to achieve scale and share your short- to-medium-term milestones, timelines and expansion plans.

3. What is the biggest barrier to the scale and transformative change you seek?

4. What external factors (i.e. social trends, policy changes, new technologies) might affect your organizational strategy? How are you factoring these risks and opportunities into your strategy?

Дата добавления: 2015-08-27