Youth Accelerator for Change (YAC) Fund Supporting Youth Led Social Enterprises
Application Form
Name of Organization
*
Terms of Reference (ToR)
Location of Organization
*
Greater Accra Region
Oti Region
Volta Region
District
*
Please Select
Jasikan
Hohoe
Ho
Accra Metro
Is your organization legally registered?
*
Yes
No
Is your organization headed by a young young woman, person with Disability or Refugee Minority and or supporting these category of young persons?
Yes
No
If Yes, indicate specifically
Name of organization's Lead/ Primary Contact Person
*
First Name
Last Name
Role of Primary contact person in the Organization
*
Age range of organization's Lead/ Primary Contact Person
*
18–24
25-29
30-35
Sex of Organization's Lead/ Primary Contact Person
Female
Male
Do you have any form of Disability?
*
Yes
No
If Yes, which form of Disability
Email address of Primary contact person
*
example@example.com
Mobile Number of contact person
*
-
+233
Phone Number
Mobile Number of any other team member
*
Please enter a valid phone number.
Format: (000) 000-0000.
Is your organization a Social Enterprise?
*
Yes
No
What is the nature of the enterprise
*
Agribusiness
Processing/ Manufacturing
IT
Health Services
Creative Industry
Other
If other, specify
Describe your Enterprise's core business model
*
What is your main source of funding?
*
How much revenue has your Social Enterprise generated over the past 6 months?
*
Provide a realistic timeline for activities. For each milestone, provide date to be implemented
What social impact interventions is your organization focused on?
*
Sexual Reproductive Health Right(SRHR)
Gender Based Violence
Climate education, mitigation and adoptation
Education
Youth Participation in leadership
Support to persons with Disability
GirlsLeadership in STEM (Coding and Robotics)
Economic empowerment of young people, including persons with disabilities and refugee minority group.
Partcipation/Collaboration in collective advocacy efforts by She Leads Social movement to advancinggender equality and girls’ rights
Other
If other, specify
Describe your organization’s main social impact intervention over the past year
*
What stage of support are you applying for ?
*
Idea Stage
Build Up Stage
Why are you applying for this support? Describe how the support will benefit your organization
*
Describe your scalability and sustainability approach.
*
Total requested Amount (if applying for Build up Stage)
*
Has your organization previously received funding from Plan International Ghana?
*
Yes
No
If Yes, what kind of support?
*
Profile of Social Enterprise; Business Model and Social Impact Intervention
*
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Itemized Budget
*
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Kindly upload the proposal budget here
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