GRANT APPLICATION
CLIENT PRE-ASSESSMENT FORM
Branch
Area
Province
Clients Reference No.:
Clients Name:
Assessor Name
Position
Date
Outcome of the assessment Approved Referral Rejection
Comment on Assessment
(Assessor)
Follow-up on Assessment
Outcomes
NYDA/ GRANT PROGRAMME
PERSONAL PROFILE OF POTENTIAL CLIENT(S)
1. Client Name and Surname: _______________________________________________________
2. South African Citizen Identity Number: ______________________________________________
3. Contact details: Home Telephone: ____________________ Cell: _____________________
4. Fax Number: ___________________________________
5. E-mail address: _____________________________________________________________
6. Physical address: _____________________________________________________________
______________________________________________Postal Code: _____________________
7. Geographic Location (Rural/Peri-urban/Urban) : ______________________________________
8. Marital status: ____________________________
9. No. of Children: No. of other family members you are currently supporting:
10. Are you related to any NYDA staff or Board member? Yes No
If yes, indicate who __________________________________________________
Educational Information (Highest level of Education achieved):
1. Highest standard passed: (e.g. grade R – Matric)_____________________________________________
2. Tertiary education (e.g. certificate/diploma/Degree etc.:_______________________________________
3. Please specify the field of study: __________________________________________________________
Employment History:
1. Are you currently employed? Yes No
If yes, for how long?
If no, indicate if you have any previous work experience? (Please explain) ________________________
____________________________________________________________________________________
____________________________________________________________________________________
General Information
1. The purpose for your visit to NYDA? (Intervention required)?
____________________________________________________________________________________
2. Have you benefited from any NYDA funded services before? Yes No
If Yes Please specify: __________________________________________________________________
3. Are you willing to participate in the NYDA Business Development Support if assessed to be requiring them?
Yes No
If no, indicate why:____________________________________________________________________
____________________________________________________________________________________
NYDA/ GRANT PROGRAMME Page 1 of 7
Entrepreneurial Analysis
1. Do you have a business Idea? Yes No
No (if no, refer to EDP training, starting with awareness)
Yes (if yes, follow the questions on the Start Up)
2. Are you currently running your own business? Yes No
No (if no, follow the questions on the Start Up)
Yes (if yes, follow the questions on the Existing Business)
3. Do you have business plan? Yes No
Yes, (if yes, refer for evaluation)
No (if no, refer for training)
Start Up (client who has a viable business idea to start the business)
1. Why do you want to start a business? ______________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
2. Indicate the sector in which the business will be operating: _____________________________________
3. Give a brief description of the idea in terms of :
a. The type of business ____________________________________________________________________
b. The need the business seeks to satisfy is ____________________________________________________
_______________________________________________________________________________________
c. The potential customers are ______________________________________________________________
d. The business operate from _______________________________________________________________
e. The product/service which the business develop are___________________________________________
f. The service be rendered are_______________________________________________________________
4. What amount of funding would you require for your business? R _________________________________
5. Assess yourself against the following business feasibility requirements:
a. What management skills/experience do you have to start the business?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
NYDA/ GRANT PROGRAMME Page 2 of 7
b. What technical skills do you have to start the business?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
c. Have you identified potential customers? Yes No
If yes, who are they ______________________________________________________________________________
d. Do you have any funds to invest in the business? Yes No
If yes, how much?________________________________________________________________________________
e. Do you have any equipment to start the business? Yes No
If yes, list them: _________________________________________________________________________________
______________________________________________________________________________________________
Existing Business (operational business)
1. Why did you start the business?__________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
2. Indicate the sector in which the business is operating? _____________________________________________
3. Give a brief description of the business in terms of :
a. The type of business: ___________________________________________________________________________
b.The need the business seeks to satisfy is to __________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
c. Who are the customers/ potential customers? _______________________________________________________
d.Where is the business operating from? _____________________________________________________________
e. What is the product/ service of the business? ________________________________________________________
f. How is the product/ service delivered/ rendered? ____________________________________________________
g. How long has the business been in operation? _______________________________________________________
h.How many people are employed by the business? ____________________________________________________
i. What is the estimated annual turnover of the business? _______________________________________________
Existing Client Business Plan
(for clients who have existing business plans, please assess the business plan using the tool provided)
NYDA/ GRANT PROGRAMME Page 3 of 7
Capacity Building
1. What skills/ knowledge do you have about the business you want to start?
2. Have you ever received Entrepreneurship training? (Yes/No)
If yes, indicate the training you received and name of the institution. (E.g. financial management, project
management, etc. and provide proof of the training received.)
__________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
0. Are you willing to attend the Entrepreneurship Development Training if required? ______________
Recommendation :
(see attached list of Entrepreneurship Development Programme Training Offerings)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________
Client Signature: _________________________________ Date: ____________________________
Assessor: ______________________________ Signature: ______________________
Position: _______________________________ Date: _________________________
NYDA/ GRANT PROGRAMME Page 4 of 7
Entrepreneurship Development Programme Training Offerings
Awareness (1-2 hrs) (Pre-start Up/ Start Up/ Existing Business)
This intervention is the basis for any training offered by EDP. It covers the following:
• Basic Entrepreneurship Skills
• Characteristics of an Entrepreneur
• Basic Business Requirements
Start Up – 1 (3 days) (Pre-start Up/ Start Up)
1. Module 1 - Demonstrate an understanding of Entrepreneurship and develop entrepreneurial
qualities
2. Module 2 – Identify, Analyse and select business Opportunities
3. Module 3 – Write and Present a Simple Business Plan
Course : Small Enterprise - Start Up (3-4 days) (Start Up/ Existing Business)
1. Module 1 – Entrepreneurial Profile
2. Module 2 – Research
3. Module 3 – Legal Aspects
4. Module 4 – Marketing Strategy
5. Module 5 – Management Functions
6. Module 6 – Costing & Pricing
7. Module 7 – Finance Management
8. Module 8 – Business Administration
9. Module 9 – Business Plan
Course: Business Planning Process (4 days) (Start Up/ Existing Business)
1. Module 1 – What is marketing
2. Module 2 – Determine the Financial requirements of the new venture
3. Module 3 – Manage Finances of new Venture
NYDA/ GRANT PROGRAMME Page 5 of 7
4. Module 4 – Procedure – a business plan for new venture
NYDA/ GRANT PROGRAMME Page 6 of 7
