2016 Anzisha Prize Application
Dear Entrepreneur,
You're taking your first step to join our support network and stand a chance of winning a share of US$100,000 to
grow your business. Thank you for sharing your business or project with us!
Une fois que vous avez terminé de remplir le formulaire de demande , s'il vous plaît envoyer un courriel le
formulaire de demande dûment rempli et toutes les photographies du projet en pièces jointes à
[email protected]. Si vous avez des questions à tous , écrivez-nous!
- L'équipe Prix Anzisha
STEP 1: CONTACT INFORMATION
Field
Applicant Response
First Name
Last Name
Email
Telephone number
(Include country code)
Nationality
What is the best way to
contact you?
(Mark your response with an X)
Email:
SMS:
Facebook:
Other:
STEP 2: ENTREPRENEUR SURVEY
These questions are for data collection purposes only, to help us better understand young entrepreneurs in Africa.
Your answers to these questions will not affect your Anzisha application.
Field
Which social media
platforms do you use?
(Mark your responses with an X)
Field
Applicant Response
Facebook:
Twitter:
Mxit:
WhatsApp:
WeChat:
Instagram:
Applicant Response
How did you hear about
Anzisha Prize?
(Mark your responses with an X)
Social Media (Facebook, Twitter, etc)
At School
Online search / Website
Family or Friends
TV
Radio
Magazine or Newspaper
Local youth organisation
Other:
Field
Applicant Response
Name an organisation in
your country that you
think does good work to
help young entrepreneurs?
STEP 3: PERSONAL INFORMATION
Tell us about yourself
Field
Applicant Response
Date of Birth
(dd-mmm-yyyy)
Gender
Female:
Male:
What is your residential
address?
Street Address
City
Country
Are you currently at school
/ studying?
(Mark your response with an X)
Do you have a passport?
Brief Biography:
Tell us a bit about yourself / your
story (200 words max)
Yes, I'm in High
School:
Yes, I'm in
University:
Yes:
No, I'm not
studying at the
moment:
No:
STEP 4: PROJECT / BUSINESS INFORMATION
Please take time to answer the following questions carefully and honestly. You are permitted to have someone assist
you in the completion of the application but the words must be your own. Please note that before finalists are
selected, all responses below are vetted to confirm accuracy. A member of our time will also meet you and visit your
project before selection. It is in your best interest to answer honestly.
Field
Applicant Response
What is the name of your
project / business?
What primary industry
would you classify your
business?
(eg. technology; health; agriculture
etc)
When did you start your
business / project?
(dd-mmm-yyyy)
Location of
Project/Business?
Street Address
City
Country
Does your business /
project earn revenue?
If yes, how much?
(Please include the currency)
Does your business /
project employ others?
If yes, how many
employees do you have?
What is your project /
business? What need or
opportunity does it
address?
What do you do? How does it
work? (150 words max)
What is your role? What is
your specific contribution
to the project / business?
(150 words max)
Yes:
No:
Yes:
No:
Describe the impact of
your business / project on
you
(What success, results or impact
have you seen for yourself, your
employees or customers? Tell us
about someone who has benefited
from your work) (150 words
max)
What difficulties have you
encountered running your
business / project?
Please describe challenges that you
have faced in growing your
business and how you have
overcome them. (100 words max)
What is your dream/vision
for your project / business
for the next 5 years? How
do you plan to scale and
grow?
(150 words max)
If you were to win $10,000
for your project, how
would you invest the
money?
(150 words max)
STEP 5: LEADERSHIP POTENTIAL
Tell us about what you value
Field
Please describe the
activity in which you
participate that is most
meaningful or important
to you.
Why is this activity most
important or meaningful to you?
What have you learned about
yourself by participating in this
activity? (200 words max)
Applicant Response
STEP 6: PHOTOS & ENTRY RULES
You're almost there! Please upload any photos or additional files you think we'd find useful (brochures,
presentations, flyers) - and tell us anything else you think we should know about you or your project!
Field
Applicant Response
Additional info (optional)
Opportunity to tell us something
about you or your project that
wasn't covered by the short answer
question?
(200 words max)
VERIFICATION FORM AND PRIZE REGULATIONS
Please read the following prize rules and regulations very carefully. You MUST sign your signature at the
bottom of this page as certification that what you have written is your own work and that you understand
the following rules and regulations:
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This application form must be completed by the applicant only.
Applicants may not submit more than one application form, unless instructed specifically to do so
by the Prize Committee.
Achievements and projects mentioned in the application form must be those that the applicant was
responsible for initiating and carrying out.
African Leadership Academy will verify each finalist’s project and impact, and prospective finalists
may be asked to submit further information about their project. Finalists must demonstrate thorough
knowledge of how they implemented the project, and other members of the community will be
interviewed to verify the impact.
All entries received before the closing date will be judged by a Prize Committee. Decisions of the
Prize Committee are final.
Finalists will be notified by the Prize Committee by 1 August 2016 with an invitation to attend the
Entrepreneurial Workshop in South Africa in November 2016. If selected, finalist must make
themselves able and available to fly down to Johannesburg on the date and time of travel that is
specified by The African Leadership Academy.
African Leadership Academy reserves the right to document all applicants including photography
and film. Finalists agree to waive any rights to photographs or other media created during the
application process or Entrepreneurial Workshop.
All applicants agree to have their images used in promotional material by African Leadership
Academy, its agent and/or sponsors of this award.
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Entry, participation or winning of The Anzisha Prize should not be construed as guaranteeing or
entitling the entrant to admission into African Leadership Academy. The processes for selecting
Anzisha Prize winners and admitting ALA students to the Academy are separate.
African Leadership Academy reserves the right to cancel, withdraw from or otherwise end or modify
this Prize offering at any time.
You must sign the bottom of this page for your application to be considered complete. Incomplete
applications will be rejected.
I hereby certify that I understand the above-listed regulations and that all information included in this prize
application is truthfully and accurately presented and is a reflection of my work alone*
I confirm