Village Capital Enterprise Questionnaire

Please take 5 minutes to fill out this 10 question survey. This will help Village Capital assess whether your enterprise is eligible to participate in one of our upcoming programs. The information you provide may be shared with Village Capital partners and investors. Selected organizations will be contacted to receive additional information about Village Capital and the application process. If you would like more information please email us at india@vilcap.com

ABOUT VILLAGE CAPITAL

Village Capital is a training, mentoring, and investment program for growing enterprises. Village Capital gathers cohorts of 12-16 entrepreneurs and provides them with a comprehensive training and mentoring program meant to improve each entrepreneurs' business. At the conclusion of the program, the entrepreneurs in the cohort will vote to choose which two enterprises will receive equity investments of ~25,00,000 rupees. Village Capital is in the process of identifying interested entrepreneurs who could participate in upcoming Village Capital programs in India.

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* 1. Please fill in the following contact information so that we can contact you

Name:

Company:

Address 1:

Address 2:

City/Town:

State/Province:

ZIP/Postal Code:

Country

Email Address:

Phone Number:

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* 2. If your enterprise has a website, please provide the web address:

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* 3. How many people does your organization employ?

Number of employees:

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* 4. In what year was your organization founded?

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* 5. Please describe sector(s) that best describe your enterprise? (check all that apply)

Agriculture

Consumer Products

Education

Energy

Financial Services

Handcrafts

Health

Housing

Information & Computer Technology (ICT)

Mobile technology

Retail

Waste/Sanitation

Water

Other (please specify)

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* 6. Please describe where your enterprise has received capital (check all that apply)

Self-funded

Friends

Family

Grants & Prizes (business plan competitions, donor funding, etc)

Debt (bank loan, etc)

Investors (angel investors, venture capitalists, private equity firms

Incubator

I have received no funding

Other (please specify)

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* 7. What is your organization's structure?

Non-profit

For-profit

Hybrid

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* 8. In a brief paragraph, please describe your enterprise

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* 9. Briefly describe the positive social/environmental impact your company has achieved thus far, and the positive social/environmental impact it hopes to achieve

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* 10. Would you like to receive information about upcoming Village Capital programs?

Yes