Industrial Projects Application Form Question Title OK SECTION A : About you OK Question Title * 1. First Name OK Question Title * 2. Surname OK Question Title * 3. Cellphone Number OK Question Title * 4. Alternative contact number OK Question Title * 5. Twitter handle if available OK Question Title * 6. Email adress OK Question Title * 7. Address OK Question Title * 8. City OK Question Title * 9. Province OK Question Title * 10. Country OK Question Title * 11. Age OK Question Title * 12. Home language OK Question Title * 13. South African citizen OK Question Title * 14. Do you have a disability? OK Question Title * 15. How did you hear about us? OK SECTION B : About your technical/business experience OK Question Title * 16. What is your highest level of education? OK Question Title * 17. If you have completed tertiary studies, what was your major? OK Question Title * 18. Are you currently employed? OK Question Title * 19. Are you currently studying? OK Question Title * 20. Have you previously participated in a Propella programme? If yes, please specify. OK Question Title * 21. Have you started a business before? OK Question Title * 22. Are you currently running/managing a business? OK Question Title * 23. Is your business registered? OK Question Title * 24. Is it a company or NPO? OK Question Title * 25. Please provide your CIPC registration number OK Question Title * 26. Company name OK Question Title * 27. B-BBEE level OK Question Title * 28. How many employees do you have? OK SECTION C: About your innovation OK Question Title * 29. Describe your product/innovation?(Max.50 words) OK Question Title * 30. Does it exit anywhere else in South Africa? OK Question Title * 31. Does it exist anywhere else in the world? OK Question Title * 32. What customer segment does your product serve? OK Question Title * 33. How big is the problem/opportunity that your product intends solving? OK Question Title * 34. Why is it a problem worth solving? OK Question Title * 35. What do you think would be the most costly element when trying to get your product to market? OK Question Title * 36. Are you seeking investors? OK Question Title * 37. Why is NOW the right time to solve the problem/opportunity? OK Question Title * 38. Who else is trying to solve the problem/who are your competitors? OK Question Title * 39. How do you think this innovation will generate revenue? OK Question Title * 40. Is there more than one way that the innovation can make money? OK SECTION D: About your product/development OK Question Title * 41. Do you have a rough prototype/proof of concept(demonstrates crude/basic functionality)? OK Question Title * 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 OK Question Title * 43. Have you completed a business case/feasibility study that demonstrates technical and economic favourability? OK Question Title * 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) OK Question Title * 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? OK Question Title * 46. How would you describe your technical ability and interest? OK Question Title * 47. Write 3 words that would best describe yourself? OK Question Title * 48. Do you require warehouse space for developing your product/prototype? OK Question Title * 49. Do you require office space? OK Question Title * 50. Do you have your own workshop equipment, tools etc.? OK Question Title * 51. What other specific things would you like to get out of Propella? OK 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. OK DONE