IOC Application Form - Innovators OC

1 General Information

2 Vision and Plan

3 SWOT Analysis

4 Leadership

5 Financials

Organization Name
Primary Contact
First Last
Primary Contact Email
Tax ID #
Legal Structure of the Organization
Website
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Location (if different from address above):
HQ Phone
Please identify the sector that most closely identifies with your organization:
Who do you serve?
Year Founded
How did you hear about InnovatorsOC?

Describe your vision in 50 words or less
What is your local, Orange County impact?
What significant social problem do you address?
What do you do to solve this problem?
What is the current status of your development?
How do you plan to measure success?
Measuring Success (Please check all that apply)
- There is an independent evaluation of program outcomes
- We have an internal scorecard to track key performance indicators
- We survey beneficiaries about program quality and impact
- We measure program outcomes against averages or benchmarks
How do you plan on attaining self-sustenance?
What have been your most significant results? Provide relevant benchmarks.
Do you have proof of concept (if applicable)?
Cite one recent and significant program improvement.
What is your plan for the future? Provide timeline and goals for the next 1-5 years.

CEO Name & Tenure
Total CEO Compensation
Is there a formal CEO Annual Evaluation?
- Yes
- No
Staff Turnover Rate
List your key team members, their roles, and how much time they dedicate to your organization:
How long have the founders known one another or worked together?
Provide Three References
Resume of Primary Contact
Resume of Second Team Member
Resume of Third Team Member

Cash reserves on hand
Current net assets
Total current debt
Total dollars invested or donated to date:
List your top three investors and the amount they donated.
Do you have written financial controls?
- Yes
- No
Is your annual report posted on your website?
- Yes
- No
Fiscal Year 2011
Revenue Donations/ Investments Admin Expenses Program Expenses Other Expenses Total Net Profit (or loss)
Fiscal Year 2012
Revenue Donations/ Investments Admin Expenses Program Expenses Other Expenses Total Net Profit (or loss)
Fiscal Year 2013
Revenue Donations/ Investments Admin Expenses Program Expenses Other Expenses Total Net Profit (or loss)
Fiscal Year 2014 (projected)
Revenue Donations/ Investments Admin Expenses Program Expenses Other Expenses Total Net Profit (or loss)