All fields are mandatory

Part One: Individual Information

First Name

Last Name

Gender—Please choose an option—MaleFemaleOther

Residence (City & Country)

Personal Email Address

Work Email Address

Confirm Work Email

Cell Phone Number (Including Country Code)

Part Two: English Proficiency

English ProficiencyEnglish is my native languageEnglish is not my native language

Part Three: Organisation Information

Organisation Name

Organisation Website

Designation at the Organisation

Where is your Organisation Headquartered?

Organisation Assets Under Management (in US dollar)

Please list your Organisation’s Countries of Operation.

Nature of BusinessCorporate/Corporate FoundationFaith-based/Religious EntityGovernmentSustainability-Aligned Fund ManagerIncubator/AcceleratorHigh Net Worth IndividualAngel InvestorInternational Non-Governmental OrganisationNetworkBilateral /Multilateral DonorService ProviderUniversity/ResearchDevelopment Finance OrganisationAsset ManagerFamily Office/TrustFoundationImpact FundPE InvestorVC InvestorFinancial InstitutionOther

Which other sectors or social causes does your organisation focus on?Affordable housingAgeingAgricultureArts and CultureClimate Action and EnvironmentConservationCOVID-19EducationEnergyYouth EmploymentFinancial InclusionGender Lens InvestmentGender - Health and SafetyGender - Economic EmpowermentGenderGovernanceInformation and MediaLivelihoods and poverty alleviationMental WellnessMSME finance and supportNutritionTechnologyWater, sanitation and hygieneOther

What type of financial capital do you provide?AnyConvertible DebtConvertible GrantDebtEquityGrantRevenue ShareGuarantee

What type of non-financial capital do you provide?AnyAccess to networksCoaching-mentoringFinancial management/accountingFundraising revenue strategyHuman resourcesImpact measurementInformation technologyLegal supportMarketing and communicationsOperational managementResearchStrategy consultingTrainingUse of facilitiesNot ApplicableOther

At which stage(s) of investment do you typically deploy capital?Seed StageEarly StageGrowth StageScaling / Later StageExpansion into new regions or product/service offering innovationTransition from non-profit to social enterprise business model

Please scan and upload a high-resolution profile picture/headshot in either JPG or PNG format.

Please provide;
1. a 100-word biography of yourself

2. a short overview of your organisation

This Forum will span four months for the core programme. You will be expected to attend at least 80% of the sessions and complete all pre-session readings and post-session assignments for the core programme. Are you committed to doing so?*
Yes, I am fully committedNo, I am unable to commit

How did you hear about this programme?
Social MediaAVPA Email MarketingAVPA StaffAVPA NewsletterOther

AVPA will like to continue staying in touch with you during and after the programme to support your impact investing journey. This includes - and is not limited to - learning about your speaking opportunities, your organisation’s impact investment milestones, your partnerships with other impact investors, and more. Would you like to stay in touch with AVPA?*Yes, I agree.No, I do not.

Would you like to subscribe to the AVPA newsletter to receive updates, stories, and opportunities on the African social investments landscape and the Impact space in general?Yes, I agree.No, I do not.

Would you like to receive invitations to AVPA webinars and other convenings? Yes, I agree.No, I do not.

By clicking on Submit button, I certify that:

• All the information provided is true and correct.

• I agree to the terms and conditions of this Forum.

• Once accepted, I will make my best effort to stay throughout the Forum.