Seed funding application form to the UCC Incubation Support Initiative

APPLICATION FORM FOR INCUBATION SUPPORT FOR SEED FUNDING

Please Use Capital Letters

AGENERAL INFORMATION ABOUT THE APPLICANT
Questions 1.1 and 1.3 relate to the individual who is submitting this application
1.1.Your Name
1.2.Your title/ position in the applying team
1.3.Your contacts / Physical Address
Postal Address
Tel. No. /
/ Email. /
Questions from 1.4 to 1.11 relate to the team or organisation that will be implementing the project
1.4.Name of lead applicant (team)
1.5. Team/ organisation Address / Physical Address
Postal Address
Tel. No. /
/ Fax No. /
Email /
/ Website /
1.1Employment (if any)
Full-time male employees / Full-time female employees /
Part-time male employees / Part-time female employees /
1.2 If you are a Company, please provide Company Registration Number and Date
(a copy of the certificate of incorporation must be attached)
Registration Number /
Date of incorporation
Registered core objective of the business
/
1.3 For Consortiums/Partnerships:
Please provide details of Memorandum of Understanding (MoU)/Partnership Agreement between members
1.4Describe the extent and form of participation of Ugandan nationals in the team to implement the project
1.5What is the Total Grant Amount Requested
1.6How long do you anticipate your proposed project will take to be completed? (in months)
Application Authorisation
I confirm that
  • I am the Principal Applicant for this application and I am duly authorized to sign this application.
  • To the best of my knowledge, the information provided for this application is complete and accurate and are fully aware that it is an offence to provide false or misleading information
  • Once I am granted with the funding, I understand and agree that any output of the Incubator will be principally utilized for the development of the communications sector in Uganda
Signed /
/ Date /
Questions under Section B relates to your project/idea
BINFORMATION ABOUT YOUR BUSINESS PROPOSAL
2.1What is the name of your project?
2.2Fundamental concept & business idea summary:
please give a background to your business concept or idea in terms of
  • what need or challenge it addresses,
  • the number of people affected (or potentially affected) by this need or challenge,
  • the geographic scale, specific areas or category of population affected by the need or challenge
  • the relevance of your idea in addressing this need (500 words maximum)

2.3What is the product, process or service that the business concept will offer as an output, how does it function and how is it new or innovative? (maximum 500 words)
2.4At what stage of developing your idea are you?
Thought/idea /
/ Proof of concept/Testing /
Research/Theory /
/ Product sample /
Prototype /
/ Commercialisation /
2.5How do you plan to commercialise this concept? (100 words)
Questions under Section C relates to your capacity to implement the project/idea
CINFORMATION ABOUT THE PROPOSED PROJECT IMPLEMENTATION RESOURCES
3.1Key individuals on the team
Name / Role/position / Relevant qualifications & past experience
3.2What level of expertise does your team have in project management, commercialisation and business management?
3.3How shall the UCC funds applied for be utilised? Provide breakdown in terms of the activity, its total cost and the amount sought from UCC for the activity
3.4Do you have any other funding available to implement the project? If yes, please elaborate.
3.5Do you have an agreement with any incubator or submitted such application? Please elaborate
3.6 Please Attach a Business Plan for your Innovation?

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