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SECTION A : About you

* 1. First Name

* 2. Surname

* 3. Cellphone Number

* 4. Alternative contact number

* 5. Twitter handle if available

* 6. Email adress

* 7. Address

* 8. City

* 9. Province

* 10. Country

* 11. Age

* 12. Home language

* 13. South African citizen

* 14. Do you have a disability?

* 15. How did you hear about us?

SECTION B : About your technical/business experience

* 16. What is your highest level of education?

* 17. If you have completed tertiary studies, what was your major?

* 18. Are you currently employed?

* 19. Are you currently studying?

* 20. Have you previously participated in a Propella programme? If yes, please specify.

* 21. Have you started a business before?

* 22. Are you currently running/managing a business?

* 23. Is your business registered?

* 24. Is it a company or NPO?

* 25. Please provide your CIPC registration number

* 26. Company name

* 27. B-BBEE level

* 28. How many employees do you have?

SECTION C: About your innovation

* 29. Describe your product/innovation?(Max.50 words)

* 30. Does it exit anywhere else in South Africa?

* 31. Does it exist anywhere else in the world?

* 32. What customer segment does your product serve?

* 33. How big is the problem/opportunity that your product intends solving?

* 34. Why is it a problem worth solving?

* 35. What do you think would be the most costly element when trying to get your product to market?

* 36. Are you seeking investors?

* 37. Why is NOW the right time to solve the problem/opportunity?

* 38. Who else is trying to solve the problem/who are your competitors?

* 39. How do you think this innovation will generate revenue?

* 40. Is there more than one way that the innovation can make money?

SECTION D: About your product/development

* 41. Do you have a rough prototype/proof of concept(demonstrates crude/basic functionality)?

* 42. Have you conducted any market surveys?ie Feedback from potential customers about the product/innovation. If yes, forward the surveys to grant@propellaincubator.co.za

* 43. Have you completed a business case/feasibility study that demonstrates technical and economic favourability?

* 44. How much do you think it would cost to have a completed prototype for testing in the market place? (<R10 000 and R50 000; Between R50 000 and R 100 000; Between R100 000 - R 500 000; Between R 500 000 - R1 000 000; more than R1 000 000)

* 45. An entrepreneur takes initiative, takes risks and takes responsibility for seeing their venture succeed. One a scale of one to 10 ( one being "not entrepreneurial" , 10 being Elon Musk), how entrepreneurial are you?

* 46. How would you describe your technical ability and interest?

* 47. Write 3 words that would best describe yourself?

* 48. Do you require warehouse space for developing your product/prototype?

* 49. Do you require office space?

* 50. Do you have your own workshop equipment, tools etc.?

* 51. What other specific things would you like to get out of Propella?

By submitting the application form, you certify that the information supplied on this application is true and complete to the best of your knowledge. You understand that you are not guaranteed a place on the Propella Incubation programme or have any access to other products or services offered by Propella.

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