Sustainable Partnerships Award
&
Social & Business Co-Creation: collaboration for impact
APPLICATION FORM
Introduction
The Belgian Sustainable Partnerships Award and the European Social & Business Co-creation competition are
joining forces to create an award to recognise the most innovative partnerships for their work towards providing
solutions for social issues. There will also be a strong focus on the impact on society and the company. These
two competitions are open to all, whether small to medium sized companies, large multinationals, NGOS, public
institutions*, non-profit organisations, social organisations, foundations, academic institutions*, or any other
kind of organisation active in Belgium! By completing this application form, your project will be submitted to
both the national and European competition. For the latter, several additional questions will also be listed at the
end of this document.
*Academic and public institutions will only be accepted as entrants to the European competition where the partnership formed is with at
least a social organisation and a company.
1.1.
Conditions of participation
Who can participate?
For-profit organisations and civil society representatives operating in Belgium.
Employees and clients will not be considered as members of civil society. Business federations will be considered
as “for-profit” organisations.
What kinds of project can be submitted?
Innovative projects that are a collaborative partnership between one or more for-profit organisations and one
or more civil society representatives active in Belgium.
 It must respond to a social problem in the wider sense (community, environment, etc.)
 It must have an impact on society in Belgium or elsewhere.
Why participate?
 To evaluate your efforts towards finding solutions to social issues thanks to a panel of acclaimed judges;
 To raise awareness of your collaborative social contributions;
 To share your good practice and provide a source of inspiration to others;
 To join a community of organisations and engaged individuals in both co-creation and in forging links for new
collaborations in Belgium and Europe.
 To participate in the prestigious Zermatt Summit (25 – 27 June 2014), which will bring together all the
European finalists of the “Social & Business Co-creation” award. (http://www.changemakers.com/cocreation)
1


A prize of €20, 000 and two runners up prizes of €10, 000 will be awarded to the best European co-creation
projects among the chosen finalists of the Social & Business Co-creation competition when the prizes are
awarded on 27 June at the close of the Zermatt Summit. Two “early-bird” prizes of €1,000 will be awarded to
the two best projects submitted to the European competition before 4 March 2014.
Gain visibility and receive feedback thanks to the “open source” online platform of the European
competition. (http://www.changemakers.com/co-creation ).
1.2.







How to submit your application
Applications should be sent by email to [email protected] no later than 31 March
2014.
All applications must be sent in Word format (no other format will be accepted).
Applications may not exceed a maximum of 2mb. You may include text in any form, including tables and
graphics. However the number of photos or images must be limited. All elements of your application must be
included in the application document. Except for partner logos and a photo illustrating the project (both
must be in high resolution for the website and a potential brochure), no additional documentation is
required for these awards. Please do not include any additional documentation as the jury will not take this
into account in their deliberations. Equally, links to internet pages will not be taken into consideration.
Every application must be covered by a separate application. If you are submitting in several categories or
projects, you must complete a separate application for each submission.
The application must be signed by the project manager in the for-profit organisation and in the civil society
organisation.
We encourage partners to complete the application form together.
The application may be completed in French, Dutch or English (English is strongly recommended).
1.3.
Help and advice
If you have any questions relating to this application form, please contact:
 Oriane De Vroey: [email protected], 02 515 09 76
 Jan Ockerman: [email protected], 02 469 41 20,
 Virginie Samyn: [email protected], 0495 21 14 32
1.4.
Check list
Before beginning the application, consider the following points:
A. Make sure that your partnership meets the conditions of participation as indicated above.
Read the entire application pack before beginning to complete your form in order to identify
B.
what is required of you for each section and to present your partnership in the best light.
C. Complete the application form.
Find a photo that illustrates the project and send it to us with your application form (in high
resolution for the website and a potential brochure).
D.
Collect the logos of all partners and send them to us (in high resolution for the website and a
potential brochure).
Ensure that the proof of partnership form has been signed by the project manager in the partner
E.
organisation.
F. Submit your application before 31 March!
Application Form
Project titles
Title of project (Max. 25 characters):
Sub-title of project (Max. 80 characters):
Partners
Complete for all partners in the project
MAIN SOCIAL PARTNER INVOLVED IN THE CO-CREATION PROJECT
Name of organisation:
Type of organisation (e.g. NGO, association, foundation, social organisation, etc.):
Address:
Number of full-time employees:
Name of project manager for the organisation:
Role:
Country:
Email:
Telephone:
Twitter URL:
Facebook URL:
Web address of organisation:
MAIN COMMERCIAL PARTNER INVOLVED IN THE CO-CREATION PROJECT
Name of organisation:
Address:
Number of full-time employees:
Name of project manager for the company:
Role:
Country:
Email:
Telephone:
Twitter URL:
Facebook URL:
Web address of organisation:
Project summary
Description of the project

Project summary:
Provide a brief description of the project. This text, which will act as an introduction to your project, will be
the first information seen by online visitors. [Max. 450 characters – 75 words]
About your project

The Problem:
What problem does your project try to solve? Make reference to the specific context in which you are
carrying out your project. [Max. 750 characters – 125 words]

Solution:
Explain the solution that you have provided in three or four short sentences.
Note: The best solutions will tackle the underlying/ original causes of the problem identified. [Max. 750
characters – 125 words]

Co-creation model:
In what way is your partnership essential to the project? How does it generate value? Describe the strategic
partnerships involved in your co-creation model.
Type of
partner
(business/
social/
public)
Name of
partner
Short description
[Max. 150
characters – 25
words per
partner]
Interest in the
participation in
the co-creation
project
[Max. 180
characters – 35
words per
partner]
Contributions to the cocreation project.
What resources have been
made available for the
project (human, financial
in nature, etc.)
[Max. 180 characters – 35
words per partner]
Partner 1
Partner 2,
etc.

Communication and dialogue with parties involved:
How have you communicated with one another as partners about your objectives and the impact of your
partnership? How have you as partners encouraged dialogue and engagement between the parties
involved? [Max. 180 characters – 80 words per partner]
Impact
 Innovation – Example:
Provide an illustration of how your solution is innovative and makes a difference (please provide a concrete
example of your project in action to indicate how you have made a social impact.). [Max. 180 characters – 80
words per partner]

Social impact:
Please describe how this program has been beneficial for society. By social impact, we mean the impact on
the beneficiaries of the partnership and society in the wider sense (community, environment, etc.). What has
been the impact of your project to date? What is your projected impact? Please provide quantitative and
qualitative data (i.e. number of direct and indirect beneficiaries). [Max. 900 characters – 150 words]

Impact on partners:
Please describe how this program has been beneficial to the for-profit organisation and the social partner (in
terms of human resources, image, work environment, local integration, reduction in costs, as a means for
mobilising other resources, creation of a new vision, new management practices, new competencies and
new organisation structures). Please provide concrete examples. [Max. 900 characters – 150 words]
 Potential impact and reproducibility:
What are your main strategies for expansion? (Geographic expansion, reform to remove political barriers,
independent replication or adoption of your idea, other mechanisms, etc.) In what way is it replicable? [Max.
900 characters – 150 words]
Approval form for partner CEOs
In order for your application to be valid, it must be accompanied by this approval form, signed by the managing
director or equivalent of all partners. If your project is being undertaken by more than two partners, the
signature of two partners is sufficient. The purpose of this approval form is to validate the application on behalf
of all partners.
We advise you to scan this part of the document in order to send it by email.
Partner 1
(for-profit organisation)
Partner 2
(civil society organisation)
Name of organisation
Registration no.
(please leave blank)
First name and surname
of CEO
Role of CEO
Signed declaration
I have read the application form for the Sustainable Partnerships Award and
the European Social & Business Co-creation competition and I confirm that it is
an eligible application and an accurate representation of our work in this field.
Signature
Media




Please do not forget to attach a photo illustrating your project (in high resolution)
Please do not forget to attach the logos of your partners
Do you have links to the social networks related to your project? If so, please share them with us! (optional)
Do you have a link to a video for your project? Help us to share your story! (optional)
Additional information for the European competition: Social &
Business Co-creation
INFORMATION TO BE COMPLETED ONLY IF YOU WOULD LIKE YOUR SUBMISSION FOR THE BELGIAN AWARD TO ALSO BE
CONSIDERED FOR THE EUROPEAN SOCIAL & BUSINESS CO-CREATION COMPETITION.
If possible, please respond to the following questions in English.
Basic information
 Progress report for the project:
“Growth” (launched and currently being expanded and developed)
“Established” (the solution has already successfully continued on from the previous stages)
“Scaling” (the solution has successfully continued on from the previous stages and the next stage is to
expand its impact on a regional or global scale)
 Year of project launch:
 Budget:
Less than €1,000
€1,000 – €10,000
€10,000 – €50,000
€50,000 – €100,000
€100,000 – €250,000
€250,000 – €500,000
€500,000 – €1,000,000
More than €1,000,000
 Has this project already received any prizes or awards? If so, which?
 Which sectors are involved in the project [maximum 4 sectors]?
Team
 Creation of the project:
What was the initiating event that caused the partners to engage with each other and believe in the success
of this project? [Max. 900 characters – 150 words]
 Team:
How does the team responsible for the project function to attain its objectives in terms of its impact? More
specifically, indicate what the role and engagement of the management of the commercial partner and the
social organisation has been in the success of the project. [max. 100 words]
About the co-creation
 Obstacles:
What main obstacles have you encountered in co-creation during the creation and implementation of your
project? How have you overcome them? [Max. 900 characters or 150 words]
 Governance:
What is the nature of your relationship with your partners (e.g. contractual relationship, joint venture, etc.).
[Max. 500 characters – 100 words]
 Interaction model:
How has the project transformed the partner organisations? How have the interactions involved affected the
management and employees of these organisations and how have they transformed their internal culture in
terms of vision, managerial practice, organisational structure or even improving and highlighting abilities?
Please provide concrete examples. [Max. 900 characters or 150 words]
Financing

Financing: How is your project financed?
Individuals
Foundations
NGOs
Companies
Regional/ local government
National government
Clients
Loans
Investors
Other


Economic viability:
Is your project economically viable? If not, what solution(s) do you envisage to guarantee the financial
viability of the project? Is the issue sufficiently important for the partners for them to support this solution?
If your project has a limited budget, what other resources do you anticipate being able to mobilise to
guarantee its maintenance or even growth? [Max. 900 characters or 150 words]

Competition:
Who else is looking at the same problem? How does your project differ from these other projects? You can
search for other projects relating to your issue on www.changemakers.com in order to better understand
what work has already been carried out in this field. [Max. 900 characters – 150 words]
Other

References: Please provide the names of two people responsible for the project with two short biographical
sentences and an email and telephone number for each.
 How did you hear about the competition?