Client Application Form
1. General Information
2. Business Overview
3. Business Details
4. Consultancy
1. General Information
First Name
*
Last Name
*
Password
*
Repeat Password
*
Date Of Birth
*
Gender
*
Male
Female
Marital Status
*
Unmarried
Married
Widow
Divorced
Prefer not to say
Children under 18
*
0
1
2
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6
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8
9
10
Children over 18
*
0
1
2
3
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8
9
10
What is your main contact address?
Home
Business
Other
Nationality
*
American
Argentinean
Armenian
Australian
Austrian
Barbadian
Belgian
Brazilian
British
Bulgarian
Cameroon
Canadian
Chinese
Colombian
Congolese
Danish
Egyptian
Emirian
Finnish
French
German
Ghanaian
Greek
Hungarian
Irish
Indian
Israeli
Italian
Ivorian
Jamaican
Japanese
Kenyan
Latvian
Lebanese
Lithuanian
Macedonian
Malawian
Malaysian
Mauritian
Moroccan
Mozambican
Nepalese
Netherlander
New Zealander
Nigerian
Norwegian
Pakistani
Polish
Portuguese
Romanian
Rwandan
Sammarinese
Seychellois
Sierra Leonean
Singaporean
Slovenian
South African
South Korean
Spanish
Sri Lankan
Swedish
Swiss
Taiwanese
Tanzanian
Turkish
Ugandan
Zimbabwean
Burkinabe
Other, please specify
Address Line 1
Address Line 2
City
Country
Burkina Faso
Congo, Democratic Republic of the
Cote d'Ivoire
Egypt
Madagascar
Malawi
Mali
Morocco
Rwanda
Senegal
Uganda
What is your highest education level?
*
Primary
Secondary
Degree
Masters
Subject Studied
Location of Education (Town, Country)
Mobile Number 1
*
+
Country Code
*
(0)
Mobile Number 2
+
(0)
Do you have Whatsapp?
No
Yes
+
(0)
Do you have your own laptop?
*
No
Yes
Email Address
*
Skype Address
How will you access the internet?
I will use it at home
I will go to an internet cafe
I will go to Grow office
I go to a place with public wifi
other, please specify
What is the best day(s) of the week for you to have sessions with your consultant?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What is the best time of the day for you to have sessions with your consultant?
Morning
Afternoon
Night
Any
How did you hear about grow movement? please specify
*
Organization
Other Client
Grow personnel
Internet/advertising
Other, please specify
Enterprise Uganda
Educat
NABW
Please upload your photo
no file selected
Grow would like to know who to contact if we are unable to contact you?
*
First Name
*
Last Name
*
Gender
*
Male
Female
Mobile Number
*
+
(0)
Email Address
How do they know you?
Grow request 1 reference
First Name
Last Name
Gender
Male
Female
Mobile Number
+
(0)
Email Address
How do they know you?
2. Business Overview
Business Name
*
Client Business Location: Address Line 1
*
Client Business Location: Address Line 2
*
Client Business Location: City
*
Client Business Location: Country
*
Burkina Faso
Congo, Democratic Republic of the
Cote d'Ivoire
Egypt
Madagascar
Malawi
Mali
Morocco
Rwanda
Senegal
Uganda
How would you describe your business?
*
TYPE 1: An established business taking money from a customer
TYPE 2: A business that is not yet taking money from a customer
Please specify Type 2 Business
*
business plan with funding in place, in the bank
business plan with funding promised, not in the bank
business plan without clear funding
business idea, some plan and some funding
What area is your business in?
*
Manufacturing
Wholesale
Retail
Services
Agriculture/forestry/fishing
Construction
Manufacturing/extraction
Food, beverage and tobacco
Textiles
Tailoring
Leather and shoes
Wood, straw and weaving
Furniture
Paper
Petroleum products
Chemicals
Pharmaceuticals
Rubber and plastics
Mineral products
Metal
Computers and electronic
Electrical equip. / machinery
Vehicle parts
Other
Food, beverage and tobacco
Textiles
Clothing
Leather and shoes
Wood, straw and woven material
Furniture
Wood and timber
Petroleum products
Agricultural products and inputs
Hardware, paint
Electrical appliances
Books, newspapers and stationary
Music and video recordings
Sport equipment, games and toys
Pharmaceutical and medical goods
Cosmetic and toilet articles
Computers, phones, software
Machinery
Cars and motorcycles
General merchandise
Other
Food, beverage and tobacco
Textiles
Clothing
Leather and shoes
Wood, straw and woven material
Furniture
Wood and timber
Petroleum products
Agricultural products and inputs
Hardware, paint
Electrical appliances
Books, newspapers and stationary
Music and video recordings
Sport equipment, games and toys
Pharmaceutical and medical goods
Cosmetic and toilet articles
Computers, phones, software
Machinery
Cars and motorcycles
General merchandise
Other
Restaurants and catering
Beverage serving
Accommodation services
Publishing and broadcasting
Transport
Legal services
Consulting services
Security services
Health services
Education services
Printing/secretarial services/stationary
Gambling services
Cosmetic services
Photography services
Real estate services
Waste management
Cleaning services
Events management
Misc. events services
Automobile services
Electrical repair services
Other repair services
Financial services
Tailoring
Internet services
Other
Animal husbandry
Crop husbandry
Fishing
Other
Residential Building
Nonresidential Building
Plumbing
Heating & Air Conditioning
Painting & Paper Hanging
Electrical Work
Masonry, Stonework & Plastering
Carpentry & Floor Work
Roofing, Siding, and Sheet metal work
Other
What does your business do? What are you offering your customers?
Are there many businesses like this in your town?
No
Yes
What experience do you have of this kind of business?
When did the business start?
*
When did the business start taking money from a customer?
*
What days and hours does/ will your business operate?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Every day
Morning
Afternoon
Night
Any
Why did you start/do you want to start this business?
there was no job opportunity for me
I wanted to be my own boss
there was a problem that I wanted to solve
my job did not pay me enough money
Other, Please specify
How much money have you invested in the business and on what?
How many employees does the business have?
Please describe what jobs these are
Full Time
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30+
Part Time
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30+
Temporary
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Casual
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30+
Informal/Unpaid
0
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30+
How many business partners are there involved in the business?
0
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30+
Are you working part time or full time in the business?
Part Time
Full Time
Are you earning a salary from your business?
No
Yes
Do you have any difficulties getting your products/raw materials?
No
Yes
Who are/will be the main customers of your business?
Male
Female
Both
Please specify age range and customer type
All ages
Babies
Children
Teenagers
Adults
students
families
workers
Do you/will you have any international customers? If yes, where are they based?
No
Yes
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cabo Verde
Cameroon
Central African Republic
Chad
Comoros
Congo, Republic of the
Congo, Democratic Republic of the
Cote d'Ivoire
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Guinea
Guinea-Bissau
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
South Sudan
Sudan
Swaziland
Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Do you travel internationally? If yes, where and why?
No
Yes
How often do your customers buy from you?
daily
weekly
monthly
annually
other
3. Business Details
MARKETING
How do you/will you advertise your business to customers?
Do you/will you have a website? If yes, please state
No
Yes
Do you/will you have a business facebook page? If yes, please state
No
Yes
Do you/will you have a twitter handle? If yes, please state
No
Yes
COMPETITORS
Who is the main competitor for your business?
Where is the competition located?
How are/will you be different to your competition?
FINANCES
Do you keep financial records? If yes, how?
No
Yes
on paper/in a book
on the computer
Other, please specify
Is your business profitable?
No
Yes
I am not sure
Does your business have a bank account?
No
Yes
Do you have a separate bank account for your business from your personal account?
No
Yes
Does your business have any debt(loans)? If yes, please specify amount and where it came from
No
Yes
I prefer not to say
microfinance
saving circle
bank loans
family or friend
money lenders
suppliers
others
Are you having any difficulties paying back this debt(loan)?
No
Yes
Has the business had any grants? If yes, please specify amount and where it came from
No
Yes
I prefer not to say
Is your business registered with government?
No
Yes
How much money has been invested so far?
By when do you estimate to start generating revenue?
How much money is needed to continue with the business?
What is this money needed for?
buy new stock
buy equipment
buy land
buy premises
construct buildings
staff wages
other
Where will this money come from and when?
PREMISES
Who owns the premises where you run/will run your business from?
I own it
government
friend/ family
private individual
Do you share office with any other business? If yes, please specify
No
Yes
Does your business have any insurance?
No
Yes
EXTRAS
Do you have a full or part time job as well as this business? If yes, please tell us what you do
No
Yes
Do you have any other businesses? If yes, please specify what businesses
No
Yes
Which business do you spend the most time on and why?
Are you currently being coached or mentored by another organization or individual? (Just so we can try to work together)
4. Consultancy
What is the vision for your business in the next 3 years?
*
What are the 3 biggest challenges you face in your business today?
*
Market development and marketing
Stiff competition from other businesses
Customer service
Human resource management
Finance planning and management
Obtaining funding
Business strategy
Other, please specify
What areas do you need help in? Please explain further
*
Marketing
Finance
Business Strategy
Operations
Customer Service
Human resource management
Legal
Other
You have 12 sessions with your consultant over the phone. Each one will be by the phone or Skype. What would you like to achieve by the end of these 12 sessions?
*
ACL Configuration
JFIELD_RULES_LABEL
Manage the permission settings for the user groups below. See notes at the bottom.
Public
–
Guest
–
Manager
–
–
Administrator
–
–
Comm Manager
–
Registered
–
–
Author
–
–
–
Editor
–
–
–
–
Publisher
–
–
Client
–
–
Country Manager
–
–
Grow Guest
–
–
Staff
–
–
Vc
–
Security Manager
–
Super Users
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Not Allowed.
Delete
Inherited
Allowed
Denied
Not Allowed.
Edit
Inherited
Allowed
Denied
Not Allowed.
Edit State
Inherited
Allowed
Denied
Not Allowed.
Edit Own
Inherited
Allowed
Denied
Not Allowed.
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Not Allowed.
Delete
Inherited
Allowed
Denied
Not Allowed.
Edit
Inherited
Allowed
Denied
Not Allowed.
Edit State
Inherited
Allowed
Denied
Not Allowed.
Edit Own
Inherited
Allowed
Denied
Not Allowed.
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Allowed
Delete
Inherited
Allowed
Denied
Allowed
Edit
Inherited
Allowed
Denied
Allowed
Edit State
Inherited
Allowed
Denied
Allowed
Edit Own
Inherited
Allowed
Denied
Allowed
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Allowed
Delete
Inherited
Allowed
Denied
Allowed
Edit
Inherited
Allowed
Denied
Allowed
Edit State
Inherited
Allowed
Denied
Allowed
Edit Own
Inherited
Allowed
Denied
Allowed
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Allowed
Delete
Inherited
Allowed
Denied
Allowed
Edit
Inherited
Allowed
Denied
Allowed
Edit State
Inherited
Allowed
Denied
Allowed
Edit Own
Inherited
Allowed
Denied
Allowed
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Not Allowed.
Delete
Inherited
Allowed
Denied
Not Allowed.
Edit
Inherited
Allowed
Denied
Not Allowed.
Edit State
Inherited
Allowed
Denied
Not Allowed.
Edit Own
Inherited
Allowed
Denied
Not Allowed.
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Allowed
Delete
Inherited
Allowed
Denied
Not Allowed.
Edit
Inherited
Allowed
Denied
Not Allowed.
Edit State
Inherited
Allowed
Denied
Not Allowed.
Edit Own
Inherited
Allowed
Denied
Allowed
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Allowed
Delete
Inherited
Allowed
Denied
Not Allowed.
Edit
Inherited
Allowed
Denied
Allowed
Edit State
Inherited
Allowed
Denied
Not Allowed.
Edit Own
Inherited
Allowed
Denied
Allowed
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Allowed
Delete
Inherited
Allowed
Denied
Not Allowed.
Edit
Inherited
Allowed
Denied
Allowed
Edit State
Inherited
Allowed
Denied
Allowed
Edit Own
Inherited
Allowed
Denied
Allowed
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Not Allowed.
Delete
Inherited
Allowed
Denied
Not Allowed.
Edit
Inherited
Allowed
Denied
Not Allowed.
Edit State
Inherited
Allowed
Denied
Not Allowed.
Edit Own
Inherited
Allowed
Denied
Not Allowed.
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Not Allowed.
Delete
Inherited
Allowed
Denied
Not Allowed.
Edit
Inherited
Allowed
Denied
Not Allowed.
Edit State
Inherited
Allowed
Denied
Not Allowed.
Edit Own
Inherited
Allowed
Denied
Not Allowed.
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Not Allowed.
Delete
Inherited
Allowed
Denied
Not Allowed.
Edit
Inherited
Allowed
Denied
Not Allowed.
Edit State
Inherited
Allowed
Denied
Not Allowed.
Edit Own
Inherited
Allowed
Denied
Not Allowed.
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Not Allowed.
Delete
Inherited
Allowed
Denied
Not Allowed.
Edit
Inherited
Allowed
Denied
Not Allowed.
Edit State
Inherited
Allowed
Denied
Not Allowed.
Edit Own
Inherited
Allowed
Denied
Not Allowed.
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Not Allowed.
Delete
Inherited
Allowed
Denied
Not Allowed.
Edit
Inherited
Allowed
Denied
Not Allowed.
Edit State
Inherited
Allowed
Denied
Not Allowed.
Edit Own
Inherited
Allowed
Denied
Not Allowed.
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Not Allowed.
Delete
Inherited
Allowed
Denied
Not Allowed.
Edit
Inherited
Allowed
Denied
Not Allowed.
Edit State
Inherited
Allowed
Denied
Not Allowed.
Edit Own
Inherited
Allowed
Denied
Not Allowed.
Action
Select New Setting
1
Calculated Setting
2
Create
Inherited
Allowed
Denied
Allowed (Super User)
Delete
Inherited
Allowed
Denied
Allowed (Super User)
Edit
Inherited
Allowed
Denied
Allowed (Super User)
Edit State
Inherited
Allowed
Denied
Allowed (Super User)
Edit Own
Inherited
Allowed
Denied
Allowed (Super User)
1. If you change the setting, it will apply to this item. Note that:
Inherited
means that the permissions from global configuration, parent group and category will be used.
Denied
means that no matter what the global configuration, parent group or category settings are, the group being edited can't take this action on this item.
Allowed
means that the group being edited will be able to take this action for this item (but if this is in conflict with the global configuration, parent group or category it will have no impact; a conflict will be indicated by
Not Allowed (Locked)
under Calculated Settings).
2. If you select a new setting, select
Save
to refresh the calculated settings.