COURSE APPLICATION FORM To be filled by the Applicant

ENTREPRENEURSHIP TRAINING Workshop

Dear Applicant,

We would like to thank you for your interest in participating in the Entrepreneurship Training
Workshop, which is based on the acclaimed EMPRETEC approach to improve entrepreneurial
competencies.

In order to assess your personal competencies and your individual learning needs as well as
the potential impacts of the training on you and your business/organization, we would like to
invite you to this pre-training assessment. Your individual entrepreneurial competencies will
then be assessed through a personal interview with you, for which we will contact you upon
receipt of the filled-in application.

This application form used to assess your personal as well as your business, professional
background. It will only take about 35 minutes of your time. We know that your time is scarce,
but it will be a good investment for the future.

A Note on Confidentiality:

We will ask you to share information about yourself and your business, which you might
consider as sensitive and we acknowledge your potential hesitation to provide this information.
We would therefore like to assure you that all information provided will be kept strictly
confidently and will not be shared with any third party or other business. The information will
only be used for assessment purposes and in anonymous format (names and other possible
identifications will be kept separately). We would therefore like to ask you to provide as much
and accurate information for the questions as possible.

Thank you very much for your interest and time!

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Name

Age

Sex

Educational Qualification (Highest

Level)

Current Institution/Organization

Your Position in current institution

Your Current Department and

College

Years of work experience(general)

Years of work experience at current

organization

Telephone (mobile)

Email address

Physical Address/location

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 Entrepreneurship Development Program Application Form
1. Family Status: Never married Married Divorced Widowed
2. Do you have children? Yes No
3. Did your father or mother ever own their own business? Yes No
If yes, did you work in the business? Yes No
4. Did any of your relatives besides your mother or father ever own their own business?
Yes No
If yes, did you work in the business? Yes No
5. How many people do you know well personally who own their own business?

6. Please list your past work experience below with your most recent job first:

Employer Address Phone Number Position Dates

7. Have you ever tried to start your own business? Yes No

What kind of business? ___________________________________________________
What happened to this business? ___________________________________________

8. Are you presently in business for yourself? Yes No

What kind of business? ___________________________________________________

9. If you intend to start a business or expand your current business, what kind of business will
you start/expand? (Please give details) _______________________________________

10. If you do not intend to go into business right away, how do you intend to make use of this
entrepreneurship training? ________________________________________________
11. How much capital do you think you will need to start up or expand your business?
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12. Estimate the amount from each of the following sources that you can put into
starting/expanding your business:

Your own money

Loans or gift from family

Loans or gifts from friends

Other sources: Specify:

13. Which one of the following ingredients needed to succeed in business do you think is the most
important? (Mark one only.)

Money Education Friends Motivation Other

14. Do you agree or disagree with the following statement?

“It is more important for a job to offer opportunity than security.”

Agree Disagree

15. Use your imagination and try to think of as many uses as possible for sawdust or products that
could be made of sawdust.

1. 4.
2. 5.
3. 6.

16. Do you agree or disagree with the following statement?

“There are enough opportunities for people like me to

start their own businesses in this country.”

Agree Disagree

17. Imagine that your brother or sister has sent you a gift of US$30,000 to spend as you like.
What would you do with it?

First use: ________________________________________________________________

Second use: _____________________________________________________________
Third use: _______________________________________________________________
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18. If you could have your boss’s job and salary for the next five years of your life, would you take
it? Yes No

19. How would you describe your desire to start a new business or expand your existing business?
(Mark one answer only)

Don’t know Average Somewhat strong Very strong

20. At this stage, what are the chances of success for your business? (Mark one answer only.)
10% 20% 30% 40% 50%
60% 70% 80% 90% 100%

Please explain why this is the case. __________________________________________

_______________________________________________________________________
_______________________________________________________________________
21. Are you willing to spend six uninterrupted days in the course (this training you are applying
for)?

Yes No

22. What other entrepreneurship or business development workshops or courses have you
attended? Please give dates?
Course Date

23. Please describe your business or business idea.

Name of the Company:

Describe your business or business idea:

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24. Why did choose your profession as an instructor in the University?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
____________________________________________________
25. Hadn’t you been an instructor where do you think would your career end up?
_________________________________________________________________________________
_________________________________________________________________________________
_________.
26. In the course you have been teaching at your university, what specific impactful learning
approach that you would like to share as an example for others. Please be specific:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________.

27. Have you been engaging in extracurricular initiatives (individually or in a group) in your
university in relation to courses you have been teaching? Yes/No
If Yes, please describe them focusing on its outcomes:
_________________________________________________________________________________
_________________________________________________________________________________
_______________________
28. Have you been doing research in your university? Yes/No
If yes, specifically describe how your research results impacted your specific course:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

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_________________________________________________________________________________
___________
29. Have you ever travelled outside your university to engage in extracurricular activities
(workshops, conferences, industry visit etc. Yes/No
If yes, please indicate, Purpose, date and the outcome of your engagement:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_______________

Thank you very much for your time!

Please return the completed form to the University’s Entrepreneurship and Business
Development Directorate Office or Submit via the online application portal.

Signature of the Applicant: __________________

Date: ____________________________________

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