Application Form

Fill in all fields in the form to the best of your knowledge, any false information provided shall lead to automatic disqualification from the program.

Introduce Yourself:

Applicant Names *

First

Last

Email Address *

Phone No. *

What role do you play in the business? *

County *

Your Business:

Name of the business: *

Is your business registered? *

Yes No

Business Form of Registration *

Which sector is your business? *

How long have you been in operation? *

Business Location *

Website / Social Media Page URL: *

Your Solution:

What does your business do? (Your value proposition) *

Which problem or opportunity is your business addressing? *

What product or service does your business offer? *

How does your product or service solve customers' problem / pain? *

Who does your product or service serve? (Customer segments) *

Who are your main competitors (give atleast 3)? *

What is your main competitive advantage? *

Your Business Model:

How does your business make money? (List your revenue streams) *

What is the total revenue turnover in the last 12 months? KES *

How do you plan to grow / scale your business in the next 2 years? *

What is your estimated revenue turnover in the next 12 months? KES *

Impact your business make:

How does your business create social or environmental impact? Quantify your answer: *

Which are 3 important milestones that your business has achieved so far? *

What is your next big milestone? *

Have you participated in any other business accelerator program before? * *

Yes No

Have you previously received investment of any kind? *

Yes No

If yes you have previously received investment, state which form of investment. *

About your team

How many people are in your team (including yourself)? *

What skills do co-founders have that add value to your business? *

Miscalleneous Info

If successful, what are the 3 things you want to achieve through the Hazina Accelerator Program? *

How did you hear of Hazina Accelerator Program? *

If selected you will be required to pay KES 15,000/= for 3 months online training, are you willing to pay the fee? *

Yes No