The OXFO x FMDQ Innovate Nigeria Application Form 2021-22 PART 1: Lead Applicant Information • First name • Last name • Email address • Phone number • Gender • What is your role within the venture? • Ethnicity • Nigerian State of residence • Address • City • Level of education PART 2: Venture Information • Venture name • Venture URL • Venture industry sector • Location of venture HQ • Which year was your venture founded? • What is your venture transactional type? • Would you classify your venture as a socially/purpose driven business? • Does your venture address any of the United Nations (UN) Sustainable Development Goals (SDGs)? • What drives you to tackle this SDG(s)? (200-word limit) • In less than 100 words, tell us what your venture is in the simplest terms possible • Tell us more about the problem you’re solving (200-word limit) • Tell us more about where you are now as a business (200-word limit) • Tell us more about why you started this venture (200-word limit) • Tell us about your team (200-word limit) • Tell us more about what you have planned ahead (200-word limit) • Has your company raised any funding yet? • Is your venture generating revenue? • Are you planning to seek funding during the next twelve months? • What is the current number of active Mentors & Advisers to your venture? • Has your company received any awards, media attention or recognition? • Total number of Social Media Followers PART 3: Team Information • For each member of your team, please state their name, their role within the team, and how they contribute to addressing the problem that your venture is looking to solve? • If accepted into the programme, can all founders participate in the programme? Please explain current availability and obligations below • How many current team members does your venture have? • How many existing team members are male?
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How many existing team members are female? Please confirm whether all members of the founding team are Nigerian residents What State(s) in Nigeria are the founding team members from? How many of your existing team are from another ethnic background outside Hausa, Igbo, Yoruba or Ijaw?
PART 4: Legal Information • Have you incorporated, or formed any legal entity? • Who owns the IP (Intellectual Property) for your idea? PART 5: Additional Information • How did you hear about the OXFO x FMDQ Start-up Bootcamp? • Are you currently participating - or have you previously participated - in any other accelerator or incubator programme?