APPLICATION FORM
Family Name:______________________________ First Name: _____________________________
Postal Address: __________________________________________________________________________
Tel: ______________________________________ Email: _________________________________
01. Age in years [ ] less than 24 [ ] 25 – 45 [ ] 46 – 55 [ ] >55
02. Family Status: [ ] Married [ ] Single [ ] Divorced [ ] Single Parent
How many persons do you support, if any? ______________________________________________
03. Educational Background: (please list highest first)
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Institution |
Year |
Certificate/Diploma/Degree |
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04. Have you attended workshops, seminars or training course? [ ] Yes [ ] No
If answer to above is YES, please indicate details
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Institution |
Year |
Course
details |
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05. Did you ever serve as a leader of a group? [ ] Yes [ ] No
If yes, please indicate your position? __________________________________________________
06. Did you ever have a family business? [ ] Yes [ ] No
If Yes, did you work in the family business? [ ] Yes [ ] No
07. Which type of business do you intend to start or expand? ___________________________________
i. Business description: ______________________________________________________________
ii. Business location: ___________________________ iii. Estimated monthly sales revenue ___
iv. How much money will you need to start your business? _________________________________
v. Please indicate how you intend to finance your business?
Own funds Family/Friends Loan: Loan
08. If you are currently employed, please explain how you will manage the business.
_________________________________________________________________________________
09. Please indicate which course(s) you would like to attend by ticking in the last column below.
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Course
Title |
Course
Centre |
Tick |
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Entrepreneur Training Course |
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Designing and using Record keeping systems |
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Doing a market survey |
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Money management seminar |
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Reading and understanding Financial Statements |
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Creating actual and projected Financial Statements |
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Marketing |
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Customer
Service |
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Building
better employees |
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Business
Law |
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Production
Planning |
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If the time indicated is not suitable, please state when you can be available for the intended course?
_________________________________________________________________________________
10. Please list the names of your 2 local referees below (No relatives)
Name: _________________________________________________________________________
Address: ________________________________ Tel: _________________________________
Name: ___________________________________________________________________________
Address: ________________________________ Tel: ___________________________________
Your Signature: _________________________ Address: _______________________________
Name: _________________________________________________________________________
Address: ________________________________ Tel: _________________________________
Name: ___________________________________________________________________________
Address: ________________________________ Tel: ___________________________________
Your Signature: _________________________ Address: _______________________________