1 of 6 DESJARDINS AWARDS 2015 • YOUNG ENTREPRENEURs ELIGIBILITY CRITERIA • Company managed by one or more young entrepreneur(s) between 18 and 35 years old. • Company in operation for at least 1 year and no more than 5 years. • Company headquarters located in Quebec or Ontario. JURY AND SELECTION CRITERIA A jury will be appointed by Desjardins to impartially evaluate candidates through a rigorous and objective process based on the following selection criteria: • Innovation and originality; • Leadership and vision; • Accomplishment and development potential; • Number of jobs created in Canada; • Financial structure; • Social involvement in the community. YES The company has been in operation for at least 1 year and no more than 5 years (as of October 15, 2015) Legal structure of the company NO INCORPORATED Date of start of operations REGISTERED COOPERATIVE OTHER (SPECIFY) WWW. Legal name of the Company Name of the person submitting the application Title of the person submitting the application Business sector GENERAL INFORMATION Civic no. Telephone Corporate web site City ADDRESS OF THE COMPANY (Head Office) Street Suite Postal Code Province Note : Please do not exceed the space provided. If necessary, you may attach a single 8.5" x 11" sheet to complete your answers. Mr. Ms. Phone number of the person submitting the application Email address of the person submitting the application Name of the President Mr. Ms. Fax Email Year the company was created Name of the account manager Name of the business centre, caisse or subsidiary Transit CAISSE OR BUSINESS CENTRE INFORMATION (if the company is a Desjardins member) COMPANY’S MISSION (purpose) Mr. Ms. Deadline for applications: March 30, 2015 YOUNG ENTREPRENEURS AWARD Name of the company the person submitting the application is workig for
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JURY AND SELECTION CRITERIAAjurywillbeappointedbyDesjardinstoimpartiallyevaluatecandidatesthrougharigorousandobjectiveprocessbasedonthefollowingselectioncriteria:
Briefly present the company (history, products and/or services, company’s evolution since creation, etc.).Maximum 15 lines or 225 words
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AChIEVEmENTS
Briefly present the company’s significant accomplishments and major steps taken to date.Maximum 10 lines or 150 words
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mARKETS
Briefly describe the company’s markets (current and targeted clientele, concurrence, etc.).Maximum 15 lines or 225 words
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DEVELOpmENT
What are the company’s development plans for the next three years? (activities, expansion, international com-merce, human ressources, equipment, etc.).Maximum 20 lines or 300 words
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fINANCING
Briefly describe the company’s financial structure and its sources of financing.Maximum 20 lines or 300 words
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Analysis of financial position (for the past three years, if applicable).6
mANAGEmENT TEAm
List all the people on the management team, their title, name and percentage of shares held.7
Name
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Title Age% of shares held
2012 2013 2014
a) Sales $ $ $
b) Workingcapitalratio Currentassets
Currentliabilities% % %
c) Currentdebtontotalfinancing % % %
d) Long-termdebtontotalfinancing % % %
e) Totalfinancing $ $ $
f) Grossprofit =Grossmargin Sales
% % %
g) Netincome =Netprofitmargin Sales
% % %
h) Numberofemployees
i) InvestmentinR&D $ $ $
j) Owners’equity $ $ $
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BOARD Of DIRECTORS OR CONSULTING COmmITTEE
If the company has a board of directors or a consulting committee with external people, name them, briefly describe their experience and indicate how often they meets.
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Name
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3)
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Title Experience
Frequencyofmeetings:
mENTOR
Please name any mentors who assist the company’s decision-makers and describe their role and the support they provide.Maximum 5 lines or 75 words
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STRENGThS
Briefly explain the company’s greatest strengths.Maximum 5 lines or 75 words
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CONTRIBUTION TO ThE COmmUNITY
The company’s social involvement and outreach (regional, provincial, national and international).Maximum 5 lines or 75 words
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If you had to choose one aspect to represent and promote the company, what would it be?Maximum 5 lines or 75 words
unlessthisdocumenthasbeencompletedbysomeoneexternaltothecompany,thecompanyconsentstotheinformationhereinbeing disclosed to the members of the jury and other parties involved in this award. If a person external to the company hascompletedthisdocument,heorshemustobtainconsentfromanauthorizedpersonatthecompanytodisclosetheinformationprovidedhereinbeforesubmittingittothejury.