EY

Entrepreneurial Winnin Women

 

Please note the form does not include a "save" or spell-check feature. We recommend you draft and save your responses offline before copying them into the form and submitting. You may print this blank application for reference.

 

How to apply:

  • Complete this online application form in its entirety no later than June 30, 2011. Be sure to check the box under Applicant Agreement, which constitutes your electronic signature and is needed for the application to be valid.
  • All fields are required. Descriptive fields should be limited to approximately 250 words each.
  • Applications will not be accepted after the submission deadline.
  • All strategic and financial information provided is considered private and strictly confidential. It will be shared only with EY Entrepreneurial Winning Women program management and our panel of independent judges who are subject to confidentiality agreements.
EY Entrepreneurial Winning Women

Eligibility:

  • The applicant must be the founding CEO of the venture and at least a 51% owner at the time of application. If there are other women co-founders, they may apply as a group if the group meets the ownership criteria. Please note that if a venture is selected for the Winning Women program, the decision as to who ultimately participates and represents the company (be it only the founding CEO or the group) will be determined by the independent panel of judges.
  • For those women who have sought outside investment, the founding woman entrepreneur may still apply if she retains a majority ownership stake after deducting all outside investments
  • The applicant's company must be less than 10 years old and have achieved at least $1 million in annual sales for each of the last two years. Typical applicant company annual revenue ranges from $1 million up to approximately $20 million.
  • Applicants who are selected must be able to attend and fully participate in the following two events:

    • Two-day EY Entrepreneurial Winning Women Orientation/Training Session on October 4-5, 2011 at EY's headquarters in New York City.
    • EY 2011 Strategic Growth Forum, November 9–13, 2011, in Palm Springs, California.
    • Because attendance at Orientation and Strategic Growth Forum is mandatory, those unable to attend both events be better served not applying.

Criteria and selection:

  • Applications will be reviewed by a panel of highly qualified judges representing successful entrepreneurs, investors and business leaders.
  • The program judges reviewing the applications and selecting the winners will be looking for entrepreneurs with the conviction, tenacity, plan and overall professional acumen to take a highpotential business and scale it into a market leader. Applicants will be expected to demonstrate qualities needed to take full advantage of this opportunity, including the level of business sophistication needed to interact effectively with the executives who comprise the EY Strategic Growth Network: award-winning entrepreneurs and other leading CEOs, venture capital and private equity investors, and EY professionals.

For more information:
Contact EY.WinningWomen@ey.com or visit www.ey.com/us/entrepreneurialwinningwomen


  Applicant information:
 

Please provide name, title and company name exactly as you would want it to appear on announcements, programs or press releases.

   
  Name(s):
 
  Title:
 
  Company name:
 
  Company address:
 
  Street:   City:
   
  State:   ZIP code:
   
  Cell phone:
 
  Company website:
 
  Email address:
 
   

  Company information:
   
  Select your industry:
Automotive
Cleantech
Distribution and manufacturing
Financial services
Health Care
Hospitality and leisure
Life sciences (including biotech, med tech, pharma)
Media & entertainment
Mining & metals
Oil & gas
Power & utilities
Real Estate and construction
Retail & consumer products
Professional services (please specify):

Technology
Telecommunications
Other (please specify):
 
 

 
  Please describe your company and its principal business activities.

 
 
Year company founded:


 
  Are you the founding CEO? Yes No
 
  Are there other cofounders of the company? If so, please provide names, titles, contact information and percent ownership among all founders:

  What percentage of the company do you presently own?

   

  Financial data:
 

For the panel of judges, financial information is an important quantifiable indicator of success. The application will be considered incomplete and the candidate will be disqualified from consideration if this section is not completed in full. This information will be kept confidential.

   
  How have you financed your business? (Please check all that apply)
Self
Family/friends
Bank financing
Angel funding
Private equity
Venture capital
Public markets
Other (please specify):
 

  Please list all current investors and their ownership stakes:

 
Have you or your company been the subject of any investigation by a regulatory agency or governing or governmental body or subject to any disciplinary action by any such agency or governing body or been the subject of any civil or criminal complaint?
Yes No

If yes, please provide a statement describing the matter and the current status.

 

    Fiscal year-end (actual)  
  Most recent year-end Second most recent year-end Third most recent year-end
Fiscal year-end            
Total employees            
Annual sales $ $ $
Income before taxes $ $ $
EBITDA* $ $ $
Total assets $ $ $
Total equity $ $ $
  * Earnings before interest, taxes, depreciation and amortization

  Please explain any unusual financial trends in the fiscal year-end financial information provided above, including any significant increases or decreases in revenue. If applicable, please also explain your intended path to future profitability if you are currently operating at a loss.




  Personal statement:
 

Please tell us the story behind your business and create a vivid picture of yourself as a woman entrepreneur who intends to run a market-leading business.

 
What inspired you to launch your company?

 

Describe your professional history prior to the creation of your company.

 

What are the major obstacles you have had to overcome in starting and/or growing the business?
Share some of the personal and/or financial risks you have taken.


 

Please describe the business model your company has successfully employed to date.


 

How do you see your business evolving in the next year? In the next three to five years?
Be specific in describing your tactical goals and what it will take to achieve them.

 

What is your strategic vision for the future of your company? Where are you taking it? How big do you think you can scale and grow this company (you may consider your answer in terms of revenue, job creation, market share, etc), as growth is an important objective for the program?


 

Describe the culture of your company and the values that guide you as a leader.
In addition, please describe your contributions and connections to community and/or philanthropic activities outside your company.


 

Describe how you have built your personal and professional advisory networks and developed relationships with mentors.


 
Why should you be chosen to participate in this program? What makes you uniquely qualified to capitalize upon this opportunity?
   

  External advisors/references:
 

Please provide contact information for up to three individuals who have assisted you in your business venture and who may serve as references. They may include board members, advisors, your banker, attorney, accountant or a valued investor who may be contacted by program management.


1.
 
  Name/title:
 
  Company:
 
  Phone:
 
  Email:
 

2.
 
  Name/title:
 
  Company:
 
  Phone:
 
  Email:
 

3.
 
  Name/title:
 
  Company:
 
  Phone:
 
  Email:
 
   

  Photograph:
 

If selected for the 2011 Class of Winning Women, the applicant will be asked to submit one professional head-shot photograph. The photo will be used for reference and production purposes related to the applicant's progression within the program and for publicity purposes if selected. By checking the box "I agree" under the Applicant agreement, the applicant hereby confirms and represents that she has obtained any and all consents or waivers required in order for EY LLP to use the photograph for the above-stated purposes.

   

  Applicant agreement:
 

Confidentiality
I understand that the information provided in this application will be used by Ernst & Young LLP, the sponsors and collaborating organizations (as regards non-financial information) and the panel of independent judges for purposes of evaluating the application and creating a press release if I am selected to be one of the Ernst & Young Entrepreneurial Winning Women. I consent to the use of such information for these purposes and hereby confirm and represent that I have obtained any and all authorizations or waivers required in order for EY LLP, sponsors and judging panels to review and utilize applicant-provided information and materials in connection with the EY Entrepreneurial Winning Women program. I further consent to the use of such information for research, educational or any other purpose as long as such use does not divulge my identity or the identity of the company to any person other than the sponsors, the judges and their respective affiliates unless I authorize such use in writing. I agree that any information discussed during the deliberations of the panel of independent judges shall be treated as confidential.

Release
In consideration of my participation in the EY Entrepreneurial Winning Women program, on behalf of myself and my heirs, executors and administrators, I hereby release and forever discharge EY LLP and its affiliates, and the member firms of EY Global Limited and their affiliates, and the partners, employees, agents, representatives, successors and assigns of each of the foregoing entities and the panel of independent judges of and from any and all liabilities, claims, actions, damages, costs or expenses of any nature arising out of or in any way connected with any information or materials submitted in connection with this application or with my participation in the EY Entrepreneurial Winning Women program, including any events, ceremonies, or promotional activities related thereto, as well as the determinations of the panel of independent judges.

Limitation of liability
In no event will EY LLP, its subcontractors, the member firms of Ernst & Young Global Limited, or the panel of independent judges be liable to me, the company or any affiliates (or any respective successors or permitted assigns) for any consequential, incidental, indirect, punitive or special damages (including loss of profits, data, business or goodwill) in connection with the EY Entrepreneurial Winning Women program, whether or not liability is based on breach of contract, tort, strict liability, breach of warranty, failure of essential purpose or otherwise, and even if EY LLP or the panel of independent judges is advised of the likelihood of such damages.

Disputes
Any controversy or claim arising out of or relating to my participation in the Ernst & Young Entrepreneurial Winning Women program shall be submitted first to voluntary mediation, and if mediation is not successful, then to binding arbitration in New York, New York, conducted in accordance with the CPR Rules for Non-Administered Arbitration as in effect on the date hereof. The arbitration panel shall have no power to award punitive damages or any other damages not measured by the prevailing party's actual damages, and I expressly waive any right that I might otherwise have to obtain such damages in arbitration or in any other forum. The result of the arbitration shall be binding on the parties, and judgment on any arbitration award may be entered in any court having jurisdiction.

Use of photo, etc.
If I am selected as one of the Entrepreneurial Winning Women, I hereby give Ernst & Young LLP and its affiliates and the member firms of EY Global Limited and their affiliates, and the partners, employees, agents, representatives, successors and assigns of each of the foregoing entities the non-exclusive and transferable right, but not obligation, to use, edit, publicize, and reproduce freely my name and other likeness, including but not limited to, biographical data, picture, portrait, photograph, film, videotape, recordings of my voice, or any written statements that I provide in connection with the EY Entrepreneurial Winning Women program, including, but not limited to, the development and publication of marketing material, promotional publications, media publications and coverage, videos and other materials, whether such items are intended for an internal or external audience. I agree that no compensation shall be due me or my company or its principals and employees for such usage.

I have read this Application Form, understand its contents, and represent that I am legally competent to sign this document on behalf of myself and my company and am not aware of any agreement with any other party that would conflict with the terms set forth herein. To the best of my knowledge, the information provided herein is true and complete. Please check the box to indicate your agreement and electronic signature.

 I agree


How did you learn about EY Entrepreneurial Winning Women? Check all that apply.

Committee of 200
National Association of Women Business Owners (NAWBO)
Women's Business Enterprise National Council (WBENC)
Women Presidents' Organization (WPO)
University alumnae outreach (specify school):

Print media
Broadcast media
EY professional
Direct email solicitation
Advisor (banker, attorney, board member, PR firm)
Other, please indicate:

For questions or additional information, please contact EY.WinningWomen@ey.com.

All applications must be submitted online by Thursday, June 30, 2011.


  Print the completed form
 

Upon completion of this online application and prior to submission, you are advised to print it for your records:





Thank you for applying to the EY Entrepreneurial Winning Women program!