Application Form

About the Application

What do you have to do?

Submit your application form online by 31st January, 2012 *** EXTENDED DEADLINE ***

Be available for a Panel Selection Presentation in early February, 2012 (EXACT DATE TBD)

Important dates to put in your diary

Submit your application form online by 31st January, 2012
Be available for a Panel Selection Presentation in early February, 2012
Be available for our residential weekend and workshop sessions on
- 24 (evening) to 26 (till lunch) February 2012
- 23 (from lunch) to 24 (till lunch) March 2012
- 20 (from lunch) to 21 (till lunch) April 2012
- 25 (from lunch) to 26 (till lunch) May 2012

Section 1

SECTION 1: ABOUT YOU AND YOUR ORGANISATION

1. Please state name, title(s) and position of yourself and up to two other relevant business partners who would possibly participate in the programme (see also question ): * (means field is required)

2. Please state full name and legal status of your company or organisation *

3. Please give contact details of your company or organisation

Address: *

Town: *

Postcode: *

E-mail: *

Website:

Daytime telephone:

Mobile telephone:

5. What is your current employment status?

Status: *

What is your job title?

Section 2

SECTION 2: ABOUT YOUR BUSINESS OR BUSINESS CONCEPT

6. Please briefly describe your company or business concept (in less than 100 words). *

7. And which of the following is most applicable to your company – please tick relevant option(s)? *
Start-up company in the process of putting the concept in placeHave recently implemented the business concept (less than 12 months ago)Have implemented the concept longer than 12 months ago (established company) Developing a high-growth in-house projectPreparing to set-up a business franchisePreparing for a MBO / EPO / IPO Preparing for a university or business spin-off

8. What makes your company or business concept different and why do you think it will achieve its high growth potential (in less than 100 words)? *

Section 3

SECTION 3: SUMMARY BUSINESS DETAILS

9. Current / historic company details (if applicable)

Turnover 2010 (actual)

Turnover 2011 (actual)

Turnover 2012 (forecast)

Profit / Loss (show loss as negative) 2010 (actual)

Profit / Loss (show loss as negative) 2011 (actual)

Profit / Loss (show loss as negative) 2012 (forecast)

No. of employees (full time employment) 2010 (actual)

No. of employees (full time employment) 2011 (actual)

No. of employees (full time employment) 2012 (forecast)

Turnover Year 1 (2012) *

Turnover Year 2 (2013) *

Turnover Year 3 (2014) *

Profit / Loss (Show Loss as negative) Year 1 (2012) *

Profit / Loss (Show Loss as negative) Year 2 (2013) *

Profit / Loss (Show Loss as negative) Year 3 (2014) *

Attach any more business plan details here

11. Please describe strengths and assets of you or your company to realise the business plan (in less than 100 words). *

Section 4

SECTION 4: REQUIRED BUSINESS SKILLS AND ACUMEN

12. Please describe your development needs or lack of skills or experience (in less than 100 words)? This could be about you as an individual or with regards to your immediate team. You should also consider potential new employees. *

13. How can you benefit from the programme and how can the programme benefit from you? *

Section 5

SECTION 5: REFERENCES AND BACKGROUND INFORMATION

14. Please provide name, position and contact details of two references – note we will not contact them without your prior approval.

Reference 1:

Reference 2:

15. Please provide some background details of yourself and, if applicable, the other associates who would be involved in the programme (per business maximum three in total). Alternatively you can attach an up-to-date CV (two pages max).

Attach up-to-date CV here

16. For the successful businesses there will be a residential weekend at the front end of the programme and three workshop sessions. It is a pre-requisite that all activities are attended by at lease one of maximum three people nominated by each company.

Our programme is planned for following dates:

Residential Weekend: Friday evening up to Sunday lunch, Fri 24th – Sun 26th Feb
Workshop Sessions 1: Friday lunch up to Saturday lunch, Fri 23rd – Sat 24th May
Workshop Sessions 2: Friday lunch up to Saturday lunch, Fri 20th – Sat 21st April
Workshop Sessions 3: Friday lunch up to Saturday lunch, Fri 25th – Sat 26th May

We charge at cost for lunches, dinners and overnight stays – £550 (excl. VAT) per participant in total. Payment is due at the onset of the programme. These costs are heavily subsidised – there is no charge for sponsors’ time, workshops and mentoring.

For queries on the programme or the application form, please email us at eps@eps-project.co.uk or telephone Helen Johnstone at Ideas In Partnership on 01771 644163

Tel: 01771 644 163

Email: eps@eps-project.co.uk

Application Form

What do you have to do?

Important dates to put in your diary