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SECTION A : About you
First Name

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* 1. First Name

Surname

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* 2. Surname

Cellphone Number

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* 3. Cellphone Number

Alternative contact number

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* 4. Alternative contact number

Twitter handle if available

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* 5. Twitter handle if available

Email adress

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* 6. Email adress

Address

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* 7. Address

City

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* 8. City

Province

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* 9. Province

Country

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* 10. Country

Age

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* 11. Age

Home language

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* 12. Home language

South African citizen

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* 13. South African citizen

Do you have a disability?

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* 14. Do you have a disability?

How did you hear about us?

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* 15. How did you hear about us?

SECTION B : About your technical/business experience
What is your highest level of education?

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* 16. What is your highest level of education?

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

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

Are you currently employed?

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* 18. Are you currently employed?

Are you currently studying?

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* 19. Are you currently studying?

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

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

Have you started a business before?

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* 21. Have you started a business before?

Are you currently running/managing a business?

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

Is your business registered?

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* 23. Is your business registered?

Is it a company or NPO?

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* 24. Is it a company or NPO?

Please provide your CIPC registration number

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* 25. Please provide your CIPC registration number

Company name

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* 26. Company name

B-BBEE level

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* 27. B-BBEE level

How many employees do you have?

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* 28. How many employees do you have?

SECTION C: About your innovation
Describe your product/innovation?(Max.50 words)

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

Does it exit anywhere else in South Africa?

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

Does it exist anywhere else in the world?

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

What customer segment does your product serve?

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* 32. What customer segment does your product serve?

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

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

Why is it a problem worth solving?

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* 34. Why is it a problem worth solving?

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

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

Are you seeking investors?

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* 36. Are you seeking investors?

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

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

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

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

How do you think this innovation will generate revenue?

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

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

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

SECTION D: About your product/development
Do you have a rough prototype/proof of concept(demonstrates crude/basic functionality)?

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

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

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* 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

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

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

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)

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* 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)

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?

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* 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?

How would you describe your technical ability and interest?

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

Write 3 words that would best describe yourself?

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

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

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

Do you require office space?

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* 49. Do you require office space?

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

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

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

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* 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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