Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
Do you identify as First Nations?
*
Do you identify as Culturally and Linguistically Diverse (CALD)?
Are you located in regional South Australia?
*
If 'YES', please indicate the region where you are located:
Adelaide Plains/Lower North
Adelaide Hills/Mount Lofty Ranges
Barossa Valley
Eyre Peninsula
Far North
Far West Coast & Nullarbor
Fleurieu Peninsula
Flinders Ranges
Kangaroo Island
Limestone Coast
Mid North (e.g. Clare Valley)
Murray Mallee
Yorke Peninsula
Do you require any special assistance or have any access requirements that we should be aware of?
Business Name
*
Business Address
*
Please provide your ABN:
*
What industry/sector does your business belong to?
*
Is your business at least 50% female-owned?
*
Number of employed FTEs (if applicable)
How many years have you been in business?
*
Are you a Franchisor or Franchisee business?
*
Does your business have an annual turnover of $250,000 or greater?
*
(Not applicable to First Nations entrepreneurs)
Please provide your annual turnover for the most recent financial year:
What are your business growth expectations for the next 2 years?
Has your business received any funding such as personal investments, Government grants, venture capital funding or crowdsourcing?
If you have received funding for your business, please specify the type of funding.
Do you have a desire to set up an Advisory Board for your business?
Please provide a description of your business, and explain what winning this scholarship would mean to you and your business.
*
Would you prefer face-to-face or online sessions?
Refer to the Scholarship Selection Criteria document in order to indicate your choice of Program selection.
*
