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About You

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Location

Project Street Address

Project City

Project Province/State

Project Postal/Zip Code

Project Country

n/a

Your idea

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Focus of activity

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Year the initiative began (yyyy)

2007

Positioning of your initiative on the mosaic diagram

Which of these barriers is the primary focus of your work?

Please select one

Which of the principles is the primary focus of your work?

Please select one

If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic:

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Name Your Project

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Describe Your Idea

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Innovation

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Define the innovation

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Context for Disruption:

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Delivery Model

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Key Operational Partnerships

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Impact

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Financial Model

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What is your annual operating budget?

What are your current sources of revenue? (please list any sources that are foundation grants)

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Effectiveness

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Which element of the program proved itself most effective?

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Number of clients in the last year?

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What is the potential demand?

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Scaling up Strategy

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Stage of the initiative:

0

Expansion plan:

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Origin of the Initiative

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This Entry is about (Issues)

Sustainability

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What are your two main challenges to finance the growth of your initiative

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How did you hear about this contest and what is your main incentive to participate?

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The Story

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Do you have an annual financial statement?

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Do you currently have an annual financial statement that tracks profit/loss?

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Please describe the amount (and/or type) of funding you need to implement your initiative, at year 1 and at year 5.

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