BF CBC APPLICATION FORM & START-UP SURVEY
The following sample Community Business Council (CBC) Application Form and Start-up Survey has been
designed for a Business Facilitation project to:
1. Streamline the ‘application’ (or a simple ‘expression of interest’) process for the Community Business
Council (CBC);
2. Collect the business owner data required for CBC Client Relationship Management (CRM) and
Monitoring & Evaluation (M&E) purposes (to be recorded in a database and tracking tool).
3. Establish entry/baseline figures for the local business environment component of a BF project, against
which progress will be measured by subsequent Progress Surveys and Project Evaluations.
NOTE: For many WV projects this survey is likely to follow an earlier sample group ‘Baseline Study’ during
which face to face interviews are held amongst business owners (or households with a business owner) to
collect community-wide baseline data. In this instance, some interview questions are repeated in this
survey; however it is important at this stage to collect this data from actual project participants.
For some grant-funded Business Facilitation projects, a community-wide baseline study is not required, so
this participant-only survey at the start of the project activities serves as the ‘baseline’ data collection tool
for the CBC/local business environment component.
Checklist for utilising this Application Form and Survey
Ensure that Business Facilitators, the M&E Team and Project Managers all agree on how and when
the survey will be conducted, analysed and reported. (For example, it can be conducted by the
Business Facilitator and analysed by both the Business Facilitator and the M&E Adviser).
Contextualise and translate the questions as required, but try to use all of the suggested questions
to enable consistent data collection across all Business Facilitation projects.
Notwithstanding your promotional efforts and making yourself available to answer questions, avoid
‘pushing’ people to sign up if they do not seem adequately interested. Participation should be
demand-led. If people are not self-motivated to join, they are more likely to drop out.
Ask interested existing/prospective business owners to self-complete all questions in the form.
Remind business owners that the information they provide will be kept confidential.
Enter data from all completed documents into your database and tracking tool, but also keep hard
copies securely according to your offices policy.
Ensure that these Application Forms are cross referenced in your database with those collected for
the Training & Coaching Program so that (i) you can track client participation levels and needs for
CRM purposes (ii) you do not double count individual responses for M&E purposes.
For more information please email business.facilitation@worldvision.com.au
Sample BF CBC Application Form and Start-up Survey, November 2015
Page 1
Business Facilitation CBC Application Form and Start-up Survey
Thank you for your interest in joining the World Vision-supported (xxx - inset name of CBC). The
purpose of this CBC is to help business owners in (insert location) to work together to identify
constraints to developing a business, and ways we can work together to overcome shared
barriers.
If you are interested in being involved in this group, please complete this form and return to
(XXXXXX). The information you provide will be kept confidential, and will only be used to:

Help us understand common business needs so we can find suitable solutions;

Keep in contact with business owners about upcoming meetings and events.
(Please note: A similar Application Form is issued for the associated Business Training and Coaching
Program. As those applications will be processed separately, please ensure you complete all questions in
this form even if you have answered them previously).
PART 1 – YOU & YOUR BUSINESS
1.1 Name:
1.2 Business Name:
1.3 Contact Address:
1.4 Phone Number:
1.5 Email Address:
1.6 Are you Male or Female? (Please circle) Yes/No
1.7 A. Do you have a disability? Yes / No (Please circle. This question is optional).
B). If yes, what support do you need to reduce the negative impact of your disability on the
running of your business? ……………………………………..…………………………….
………………………………………………………………………………………………..
1.8 How long have you been running your business?
Yet to start
<1 year
> 1 year (How many years? …….)
Sample BF CBC Application Form & Start-up Survey (November 2015)
Page 2
Business Facilitation CBC Application Form and Start-up Survey
1.9 Have you ever been a member of a Business Group / Association?
Yes / No (Please circle). B. If yes, which one/s? ………………………………………………..
1.10 What type of business do you run, or plan to run? (Please  as relevant. Multiple answers may apply).
Agriculture Sector
Other Sectors
Agri Producer
Artisan
(e.g. small-holder farmers, commercial farmers)
(e.g. craftsman/woman making products by hand)
Agri Produce Stall Holder
Manufacturer
(e.g. a ‘petty-trader’ who sells produce to public)
(e.g. those using ‘industrial equipment’ to
manufacture bulk supplies)
Agri Trader
Trader
(e.g. buyer/seller of agri products to businesses)
(e.g. wholesaler/distributers one who buy products
from/sell products to other businesses)
Agri Processor
Retailer
(e.g. processors of raw commodities)
(e.g. a ‘petty-trader’ who sells goods to public)
Agri Services
Labourer
(e.g. vets, farmer trainers)
(e.g. a builder, a cleaner, or one who installs/repairs
engines, power, plumbing, etc)
Agri Other ……………………………….
Service Provider
(Please list)
(e.g. restaurant/guest house operator, hair dresser,
taxi/truck driver, tutor, mechanic).
Fisheries
(e.g. fishermen/women, fish farming)
Yet to decide
Other ……………………………….
(Please list)
PART 3 – YOUR BUSINESS DEVELOPMENT NEEDS
3.1 What are the top 3 challenges you face in running / starting your business?
1. ……………………………..…………………………………..……………………………
2. ……………………………………………………………………………………………….
3. ……………………………………………………………………………………………….
Sample BF CBC Application Form & Start-up Survey (November 2015)
Page 3
Business Facilitation CBC Application Form and Start-up Survey
3.2 Please think about the local business environment in which you work, and the conditions that
enable or constrain you in starting/strengthening your business.
How would you score the degree to which conditions are constraining or enabling for the
following areas? (Explain the scale and circle response).
Very
Constraining
Slightly
Constraining
Neither
Enabling nor
Constraining
Slightly
Enabling
Very
Enabling
DON’T
KNOW
a) Access to the financial services
you need.
1
2
3
4
5
X
b) Access to business development
services you need (e.g. training
providers, experts).
1
2
3
4
5
X
c) Access to transport
infrastructure you need.
1
2
3
4
5
X
d) Access to the ICT infrastructure
you need.
1
2
3
4
5
X
e) Access to the utilities you need
(e.g. power water, sanitation).
1
2
3
4
5
X
f) Access to the industry-specific
technology you need.
1
2
3
4
5
X
g) Access to the suppliers/inputs
you need
1
2
3
4
5
X
h) Access to the customer markets
you want
1
2
3
4
5
X
i) Prevailing legislation and
regulations
1
2
3
4
5
X
j) Prevailing culture and
governance
1
2
3
4
5
X
1
2
3
4
5
X
k) Other (please describe) ………..…
……………………………….…
Sample BF CBC Application Form & Start-up Survey (November 2015)
Page 4
Business Facilitation CBC Application Form and Start-up Survey
3.3 What are the top 3 results you would like the CBC to achieve?
1. ……………………………..…………………………………..……………………………
2. ……………………………………………………………………………………………….
3. ……………………………………………………………………………………………….
3.4 How frequently would you be willing to participate in CBC meetings /activities?
Weekly
Fortnightly
Monthly
Other ……………
Thank you.
Sample BF CBC Application Form & Start-up Survey (November 2015)
Page 5