SEIF Application - Nova Scotia Co-operative Council

Application Form Part 1

Applicant Name(Required)

First Name Last Name

Organization(Required)

Name of Organization

Contact Person(Required)

First Name Last Name

Address(Required)

Street Address Address Line 2 City Province Postal Code

Registry of Joint Stock Number

Registration Type(Required)

Co-operative

Private Business

Community Interest Corporation

For Profit

Not for Profit

Society

Registered Charity

Select all that apply

Phone(Required)

Email(Required)

Website

Date(Required)

Project Name(Required)

Description of the Social Enterprise/Organization(Required)

Application Form Part 2

What are the Enterprise objectives?(Required)

What are the activities that will lead to the objectives?(Required)

What are the expected results and impacts?(Required)

How will you measure the results/impacts?(Required)

Describe the beneficiaries of the project?(Required)

Describe the skills of the Enterprise leadership and management team?(Required)

Who are the partners involved in the project?

Do you have an implementable business plan?(Required)

Upload

If you have an implementable business plan please upload.

Drop files here or

Max. file size: 256 MB, Max. files: 3.

Are you:(Required)

Upload

If you are a new start-up please upload your financial projections. If you are an existing enterprise please provide the last three years of financial statements.

Drop files here or

Max. file size: 256 MB, Max. files: 3.

What are the sources of financing?(Required)

How much financing are you seeking from the Social Enterprise Impact Fund?(Required)

Why is this financing necessary (what will it be used for)?(Required)

Name of the referring Credit Union:(Required)

Credit Union contact, email and telephone number:(Required)

Any other information you would like us to know?