APPLICATION FORM Please complete this form in ENGLISH and remember to attach your up-to-date CV in ENGLISH and in EU format, and send it to your local TACSO country office by the end of 15 January 2012. DETAILS OF APPLICANT 1. Name and title (Mr/Ms) 2. Job Title 3. Organisation 4. Office contact address 5. Office contact telephone number 6. Office contact email address 7. What level of proficiency do you have in spoken English? 8. Do you have any special requirements (eg accessibility requirements, dietary requirements etc.)? 9. In no more than 100 words, please describe your previous experience as a social entrepreneur, of owning or working at a social enterprise or of promoting and supporting the development of social entrepreneurship. Please refer to the definition of social entrepreneur and social enterprise in the Open Call. 10. In no more than 100 words, please describe why you would like to participate in this conference. 11. Are you willing to work with TACSO National Office to organize follow up activities in your country? 12. Please identify the four workshop topics you find most interesting from the list below: 12.1 Marketing Strategies: How to get consumers to 12.9 Cross Sector Alliances: In what way can we create shop social enterprise? effective collaboration between social enterprises and the private sector, public sector and civil society sector? 12.2Impact: How can we assess the societal impact 12.10 Enabling environment: How can governments of social enterprises?” create an enabling environment for social entrepreneurship? 12.3 Networks: What should be the role of networks 12.11 Sustainability: How can social enterprises act as a supporting social entrepreneurs and social model for CSO sustainability? enterprises? 12.4 Financing: How to connect investors and 12.12 Structures: What are the different legal and funders with social entrepreneurs? financial structures for Social Enterprises? 12.5 Social entrepreneurship and private sector 12.13 Environment and social entrepreneurship: How relations: Can corporate social responsibility serve can social entrepreneurship support the green economy? as a catalyst for strengthening social entrepreneurship? 12.6 Technology: How to use internet and social 12.14 Social entrepreneurship and youth: How to engage media as tools for social entrepreneurship? the younger generation in social entrepreneurship? 12.7 European Perspective: What is the European 12.15 Women and social entrepreneurship: What role do perspective on social innovation and social women play in social entrepreneurship? entrepreneurship? 12.8 Capacity-building: How to build skills for social entrepreneurs and social enterprises?