TiE Stree Shakti Awards 2011: Application form

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Fill this form online here:
https://spreadsheets.google.com/a/tiemumbai.org/viewform?formkey=dDlxb1J3Zm5WVDUzVkxPRjgtOGh3UkE6MQ

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TiE Stree Shakti Awards 2011: Application form

  1. 1. 2011 INSTRUCTIONS FOR COMPLETING THE APPLICATION FORMA. Objective of these Awards are: To celebrate and recognize Women Entrepreneurs.B. Award Categories: Award Category Definition Micro Enterprises A business whose annual turnover is between Rs. 1 Lakh and Rs. 10 Lakhs Small Enterprises A business whose annual turnover is between Rs. 10 Lakhs and Rs. 2 Crores Emerging Enterprises A business whose annual turnover is between Rs. 2 Crores and Rs. 10 Crores Medium Enterprises A business whose annual turnover is between Rs. 10 Crores and Rs. 25 Crores C. Broad Evaluation Criteria Innovativeness of the concept Overcoming socio economic/ familial challenges Social good Generating employment Scale of operations D. When completing the application forms: Use permanent ink only – please do not use pencil The entry form needs to be signed, at the space provided, by the participant (founder/ MD/ CEO, Chairman/ Director) and any of the following: senior employee, client or banker E. Other important matters: Participants should be Indian citizens, at least 18 years of age (as on January 1, 2011) and entrepreneurial women who have founded/ successfully led companies/ cooperative societies/ sole proprietorships/ partnerships/ etc and currently have at least 3 workers/ members of staff employed (excluding self). The form can also be downloaded from our website- www.TiEStreeShakti.org Please send the completed and signed form to TiE Mumbai, 301, Turf Estate, Shakti Mills Lane, Off Dr E Moses Road, Mahalaxmi, Mumbai – 400 011. (Phone 022-42200100 -11 or 022- 64510062) Each form can be used only for a single Entry If you have any questions about the application form, please contact 022-42200100 -11 or 022- 64510062 or email us at info@tiestreeshakti.org Please refer tothe Rules & Regulations document for additional guidelines on participation -1- © 2011, TiE Stree Shakti
  2. 2. 2011 GENERAL & PARTICIPANT INFORMATION 2 PhotosName of participant:______________________________________________________________Name of the participating organization:______________________________________________________________Type of organization: Company Registered Society Partnership Sole Proprietorship Other (please specify): _________________________Correspondence Address: ___________________________ _____________________________________________________________________________________________________City:_______ __________ State:__________________Pin code:____________Office Phone: :____________(STD code):_______ (No.):_______________Fax No.:____________________ Mobile (0):_______________________Email:__________________________________________Website:_____________________________________Designation of the participant in the organization:______________________________________Current Chief Officer Mr./ Ms.____________________________________________________ -2- © 2011, TiE Stree Shakti
  3. 3. Presence of the organization’s activities in India (states):________________________________________________________________Date of commencing operations (DD/ MM/ YYYY):____________ ______ _Total amount of initial funding Rs._________________Source of initial funding ___________________________Industry of operation ___________________________What does the organization do? What are its key product/ service or product offerings?(in not more than 3sentences ) 1. __________________________________________________________________________ ____________________________________________________________________________ 2. __________________________________________________________________________ ____________________________________________________________________________ 3. __________________________________________________________________________ ____________________________________________________________________________Who are the organization’s key customers? (in not more than 50 words) __ __________________________________________________________________________What is the progress of the organization? (estimate) 2007 - 08 2008 - 09 2009 – 10 No. of Employees No. of Customers -3- © 2011, TiE Stree Shakti
  4. 4. 2011 APPLICATION FORMA. Category applied for Micro Small Emerging MediumB. Give details about your entrepreneurial initiative for each of the following Criteria. Additional details, if any, can be attached with this application form Parameter Details Innovativeness of the concept _____________________________________________ (How is your initiative new/ different?) _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ - _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________D. What socioeconomic/ familial challenges/ hardships did you face from the time you - started the organization? How did you overcome them?(in not more than 100 words) . (E.g. Societal boycott, family opposition, lack of funding, etc) ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________I accept the rules and regulations of participation. The information provided is correct to the bestof my knowledge and belief. Name of Participant Title Signature Email: ________________________________________________________________ Mobile (0):_______________________ Date:_________________________ -4- © 2011, TiE Stree Shakti

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