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Application Form

To become a member of the BCtA, a company must submit an application form to the Secretariat providing details (both quantitative and qualitative) about their planned initiative. The form should be submitted electronically. The application aims to capture the goals, measures of success, and key features of the BCtA initiative, as well as any potential roadblocks or challenges the company expects to face during implementation. It provides not only the basis on which a company is approved to join the BCtA, but also the record of original objectives set for the initiative, against which reports are later submitted on an annual basis. All of the fields in the application form are obligatory.

Instructions

To start an application, a company should first create a username and password. Once a profile is created, a company can save and return to the application at any time until ready to submit to the Secretariat for approval.

All of the fields in the application form are obligatory. Once completed, fields 2 and 5 through 11 are made available to the public on the BCtA website, while fields 1, 3, 4 and 12 through 16 remain confidential (accessible only to the BCtA Secretariat, BCtA partners and the company). BCtA limits the range of possible responses available for some fields of the application form (e.g. type of initiative, sector, market, etc.) in order to enable the effective sorting and aggregation of data.

Field 16 of the application form requires applicants to identify a few standard indicators against which the company will report each year. Companies are requested to select at least: 1) one investment indicator, 2) one development indicator and 3) one indicator from another category. While this is the minimum requirement, companies are encouraged to report against as many relevant indicators in the application form as desired/practically feasible.

Companies are strongly encouraged to outline expected results on the application form.

Questions about the application process can be directed to the BCtA Admin.
BUSINESS CALL TO ACTION - APPLICATION FORM
1. Login
Insert a valid email address and password. These will be used as a login credentials to your account.
E-Mail
Password - Minimum 5 Characters
Confirm Password - Minimum 5 Characters
2. Company Name
Company Name
3. Company CEO
Insert name, e-mail, telephone, address, and personal assistant (PA) contact information
Name
E-Mail
Telephone (Please include international calling codes)
Address
PA contact details
Initiative Information
4. Company Focal Point
Insert name, title, e-mail, telephone, address
Name
Title
E-Mail
Telephone
Address
5. Name of Initiative
Insert name, if any
Name of Initiative
6. Type of Initiative
Choose type of initiative
1) VALUE CHAIN - the initiative aims to integrate underserved populations into a company value chain as suppliers, producers, distributors and/or employees. This could be where a company increases its local sourcing or production/manufacturing in the developing world, with a focus on underserved groups (e.g. women, indigenous, youth, previously unemployed or marginalized). It could also be an example of a company investing in skills upgrading for employees, customers or suppliers in order to optimize productivity and performance. In other instances a company could generate economic opportunities within supply and distribution channels through enterprise development activities for local small and micro enterprises.
2) GOODS AND SERVICES - the initiative aims to provide/sell products or services to low-income consumers. These products or services are adapted to the target market with respect to affordability, packaging, infrastructure, technology, and culture. In most cases, these initiatives will lead to cost and/or time savings for households, meet basic needs, and catalyze local entrepreneurship. Examples vary greatly by sector but may include the provision of financial services through mobile technology, access to appropriate and affordable household or nutritious products, or provision of low-cost health services or appropriate energy sources.
7. Sector
Choose the sector
Aerospace
Agriculture & Fishing
Automotive
Chemicals
Construction & Building Materials
Electronics
Engineering & Machinery
Extractive (Mining)
Extractive (Oil & Gas)
Financial Services
Food and Beverage (processor/producer)
Food and Beverage (retail)
Forestry
Healthcare
Hospitality & Leisure
Information Technology Hardware
Insurance
Manufacturing
Media
Other
Personal Care & Household Products
Pharmaceutical & Biotechnology
Professional / Support Services
Real Estate
Software & Computer Services
Steel & Other Metals
Telecommunications
Textiles & Furnishings
Transportation & Logistics
Utilities (Energy, Sanitation, or Water)
8. Market/Region
Choose the market/region of the initiative.
Latin America and the Caribbean
Sub-Saharan Africa
North Africa and the Middle East
Asia
Europe and Eurasia
Australia and Oceania
9. Phase of Initiative

Select phase of the initiative
1) Pilot - the business model is brand new; it is still being designed and tested, probably on a small scale or particular market
2) Roll out - the business model has been piloted and is being rolled out across the intended markets
3) Scale up - the business model has been successfully implemented in one or more markets and is being extended, adapted or replicated
10. Millennium Development Goals
Select Millennium Development Goal (MDG) the initiative addresses. Please press down CTRL while clicking to select multiple items. To learn more about the MDGs, please see http://www.un.org/millenniumgoals/.
MDG 1. Eradicate extreme poverty and hunger
MDG 2. Achieve universal primary education
MDG 3. Promote gender equality and empower women
MDG 4. Reduce child mortality
MDG 5. Improve maternal health
MDG 6. Combat HIV/AIDS, malaria and other diseases
MDG 7. Ensure environmental sustainability
MDG 8. Develop a global partnership for development
11. Headline Objectives
Insert 2 - 3 objectives capturing the main objectives/targets for the initiative. These should be SMART (Specific, Measurable, Achievable, Realistic, and Time-bound). For example, by 2020, Company XYZ will integrate 10,000 small-scale farmers in Uganda into its value chain.

Objective #1
12. Description of Initiative (Expected length: approximately 2 pages)

The description should focus on the forward-looking initiative. Please do not describe past initiatives in this space.

Insert a descriptive overview of the initiative, including (but not limited to) the following:

  • Why is it being implemented? (e.g. background, market context, company context)
  • What are the main goals of the initiative? (e.g. key objectives, how this is significant for the company)
  • Where is it being implemented? (e.g. specific countries, regions, etc.)
  • When is it being implemented? (e.g. specific timeframe for this commitment)
  • Who is implementing it? (e.g. main partners)
  • How is it being implemented? (e.g. basic business model, resources, implementation mechanisms)
13. Relevance of Initiative to Core Business (Expected length: approximately 1 page)
Insert text describing how this initiative fits with the company's core business, as opposed to being philanthropic.
  • Provide a brief description of what the company does as a whole.
  • Include how the initiative impacts the company's bottom line by, for example, reducing costs, generating profits, increasing market share, etc.
  • Provide some financial figures around the initiative (investment, costs savings, expected revenues, etc.) NOTE: This information is confidential and will not be shared with third party sources.
  • Discuss where the funding will come from and if it has been secured
14. Relevance of Initiative to Development (Expected length: approximately 1 page)
Insert text describing how this initiative is expected to impact positively on development, growth and/or economic opportunities for low-income people. This should include (but is not limited to) information about:
  • The scale of impact the company expects to have with this initiative (e.g. projected # of people affected, jobs created, enterprises developed, services provided).
  • The sustainability of the expected impacts, where possible. This may be based on evidence collected from similar projects elsewhere.
  • The possibilities for adapting, replicating or scaling up the initiative in other contexts/markets.
  • How the company will measure the impacts of this initiative.
15. Risks and Mitigation Measures (Expected length: approximately 1/2 page)
Insert text describing the key risks to the success of the initiative and any risk mitigation measures being undertaken.
16. Key Indicators
Note: It is compulsory for all companies to select at least one investment indicator, one development indicator and one indicator from another category. (e.g. Job Creation, Human Capital Development, Access to Goods and Services, Enterprise Development, or Income Generation)
Please express all monetary values in US dollars.
INVESTMENT
  IndicatorExpected ResultsMethods/Comments
 Total invested in company initiative
 # of new customers
 # of which are women
 Revenues generated as a result of initiative (USD)
 Cost savings to company as a result of initiative (USD)
 Profits generated as a result of initiative (USD)
 % increase in local sourcing as a result of initiative
 % increase in local production as a result of initiative
 # of people with increased productivity/revenue generating activities as a result of initiative
 # of which are women
JOB CREATION
  IndicatorExpected ResultsMethods/Comments
 # of full time jobs created
 # Direct (Employees)
 # of which are women (Direct)
 # Indirect (Suppliers/Distributors)
 # of which are women (Indirect)
HUMAN CAPITAL DEVELOPMENT
  IndicatorExpected ResultsMethods/Comments
 # of people receiving training/education
 # Direct (Employees)
 # of which are women (Direct)
 # Indirect (Suppliers/Distributors)
 # of which are women (Indirect)
 Total invested in training (USD)
 Total invested per person trained (USD)
ACCESS TO GOODS AND SERVICES
  IndicatorExpected ResultsMethods/Comments
 # of units or unit services sold
 # of which are to women
 # of individuals reached by product/service
  # of which are women
 # of households reached by product/service
 # of which are headed by women
 Price as % of disposable income of target consumers
 Cost savings (per individual or household) as a result of access to as product/service versus existing or previous product (USD)
 Time savings (per household) as a result of product/service versus existing or previous product (hours per week)
ENTERPRISE DEVELOPMENT
  IndicatorExpected ResultsMethods/Comments
 # of MSMEs targeted by initiative
 # of which are women-owned
 # of new MSMEs established
 # of which are women-owned
 # MSMEs receiving financing
 # of which are women-owned
 Amount of total financing made available to MSMEs (USD)
 Amount of financing made available to women-owned MSME's (USD)
 Average amount of financing per MSME made available (USD)
 Average amount of financing per women-owned MSME (USD)
 Total value of contracts to MSMEs (USD)
 Total value of contracts to women-owned MSMEs (USD)
 Number of new contracts between company and MSMEs
 Number of new contracts between company and women-owned MSMEs
 Average additional revenue generated by new/strengthened MSMEs (USD)
 Average additional revenue generated by women-owned MSMEs (USD)
 # of MSMEs strengthened as a result of the initiative
 # of which are women-owned
INCOME GENERATION
  IndicatorExpected ResultsMethods/Comments
 Average % increase in income of target population as a result of the initiative
 Direct (Employees)
 Average income earned by women (Direct)
 Indirect (Suppliers/Distributors/Customer)
 Average income earned by women (Indirect)
DEVELOPMENT
  IndicatorExpected ResultsMethods/Comments
 # of greenhouse gas reductions achieved through initiative (CO2 equivalent)
 # of people with improved access to water as a result of initiative
 # of which are women
 # of people with improved access to energy as a result of initiative
 # of which are women
 # of people with improved access to sanitation as a result of initiative
 # of which are women
 # of people experiencing better agricultural yields as a result of initiative
 # of which are women
 # of people with improved nutrition as a result of initiative
 # of which are women
 # of people with increased access to financial services as a result of initiative
 # of which are women
 # of people with improved health outcomes as a result of initiative
 # of which are women
 # of people experiencing a reduction in information asymmetry as a result of initiative
 # of which are women
 # of people experiencing improved living conditions
 # of which are women