WORTH APPLICATION FORM
STAGE 2: QUALITY AND OPERATIONAL CAPACITY
1. Partnership Information
Partner 1 (Partnership Leader): Applicant Organisation Information*
Mark “x” in the appropiate box:
Designer (SME/start-up): / SME Manufacturer or crafter: / Technology Provider (SME/start-up):Name
/ :Trade name (brand) (if applicable) / :
Date of Establishment (If applicable-mandatory for companies) / :
Business Sector
/ :Legal Status
/ :Registered Address / :
Country / :
Telephone Number / :
Mobile No. / :
Email Address / :
Skype account / :
Webpage ( if applicable) / :
Social media accounts (if applicable) / :
VAT Number / :
ID Number
Total revenues (for the last 2 years) / : / 2016:
2015:
Profit/loss (for the last 2 years) / : / 2016:
2015:
Partner 2 Organisation Information:
Mark “x” in the appropriate box:
Designer: / SME Manufacturer or crafter: / Technology Provider:Name
/ :Trade name (brand) (if applicable) / :
Date of Establishment (If applicable-mandatory for companies) / :
Business Sector
/ :Legal Status
/ :Registered Address / :
Country / :
Telephone Number / :
Mobile No. / :
Email Address / :
Skype account / :
Webpage ( if applicable) / :
Social media accounts (if applicable) / :
VAT Number / :
ID Number
Total revenues (for the last 2 years) / : / 2016:
2015:
Profit/loss (for the last 2 years) / : / 2016:
2015:
Partner 3 Organisation Information:
Mark “x” in the appropriate box:
Designer: / SME Manufacturer or crafter: / Technology Provider:Name
/ :Trade name ( brand) (if applicable) / :
Date of Establishment
(If applicable-mandatory for companies) / :
Business Sector
/ :Legal Status
/ :Registered Address / :
Country / :
Telephone Number / :
Mobile No. / :
Email Address / :
Skype account / :
Webpage (if applicable) / :
Social media accounts (if applicable) / :
VAT Number / :
ID Number
Total revenues (for the last 2 years) / : / 2016:
2015:
Profit/loss (for the last 2 years) / : / 2016:
2015:
2. Provide a brief description of your Partnership (experience, activities, personnel, previous collaborations).
Partner 1 (Partnership Leader):
Profile/activities (1.500 characters)
Background (1.500 characters)
Experience/collaborations (1.500 characters)
How is your previous experience/previous collaborations relevant in this project? (1.500 characters)
What value can you bring to a partnership? (1.500 characters)
Partner 2:
Profile/activities (1.500 characters)
Background (1.500 characters)
Experience/collaborations (1.500 characters)
How is your previous experience/previous collaborations relevant in this project? (1.500 characters)
What value can you bring to a partnership? (1.500 characters)
Partner 3:
Profile/activities (1.500 characters)
Background (1.500 characters)
Experience/collaborations (1.500 characters)
How is your previous experience/previous collaborations relevant in this project? (1.500 characters)
What value can you bring to a partnership? (1.500 characters)
3. Project idea basic info:
a. Project idea name (100 characters)
b. Please choose the sector of the idea
· Textile/Fashion
· Jewelry
· Footwear
· Leather/Fur
· Furniture/Home decoration
· Accessories
· Other. Please specify: …………………..
c. Please choose the category of the idea
· Designer-led project
· Manufacturer-led project
· Technology oriented project
d. What are your project objectives? (1.500 characters)
4. Please provide a clear description of your idea/project and elaborate on the expected benefits to your potential clients (5.000 characters)
5. Please tell us what development stage you have reached and how WORTH will help you to move forward onto the next stage.
Have you already begun any work towards this idea? If yes, please tell us more.
What product or prototype will the project produce?
Who is the target market? (5.000 characters)
6. What do you want to achieve? What are your goals? How does the project fit with your strategy? How will this project benefit you? E.g. new skills, increase profits, expand in new markets (3.500 characters)
a. At company level
b. At partnership level
7. What makes your idea innovative? (3.000 characters)
8. Will you apply a new technology/technique? If yes please tell us more. (2.500 characters)
9. Please provide a brief plan on the commercialisation of the project outcome i.e. target markets/segment. (2.500 characters)
10. Does this project address typical problems in an innovative way with regard to market and/or environment and/or society? If yes please tell us more.
Social impacts:Environmental impacts:
Economic/ market impacts:
(Social impact, environmental impact, economic impact).
11. Why should WORTH Partnership Project support your idea/project? You can send us creative material (e.g. video, presentation) to justify your reply.
(2.000 characters) Video 3 min max. no more than 5MB or upload a link. Answers to the questions 6 and 11 most be included
12. Main Project Contacts
Applicant main contact:
Name in English
/ :Position/Relation to Applicant / :
Department (if any) / :
Organisation Name / :
Telephone Number / :
Mobile No.
Email Address / :
Partner 2 main contact:
Name in English
/ :Position/Relation to Applicant / :
Department (if any) / :
Organisation Name / :
Telephone Number / :
Mobile No.
Email Address / :
Partner 3 main contact:
Name in English
/ :Position/Relation to Applicant / :
Department (if any) / :
Organisation Name / :
Telephone Number / :
Mobile No.
Email Address / :
13. Project Team
No. / Name / Position / Organisation Name / Tel. / Mobile No. / Email14. Budget Breakdown
(add subcategories where needed)
Budget Category / Description / Budget / PartnerStaff Costs
Admin
Materials
Travel
External services (legal, IPRs, research and development etc. give examples)
Other
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