I confirm that I am fully aware of the eligibility criteria, and based on its description, I am eligible to apply to the CSV Prize 2017.

• Yes, I'm eligible

Preferred language

• Portuguese

Organization name

Year founded

Initiative stage

• Growth (the pilot has already launched and is starting to expand)

Annual budget in 2017 (USD)

• $250k - $500k

Number of beneficiaries impacted so far

• 50,000 - 100,000

Organization type

• Nonprofit, NGO, or citizen sector

Secondary Focus Area

• Water
• Rural development

Headquarters location: Country

• Brazil

Headquarters location: City

Location(s) of impact

Website

Facebook URL

Twitter URL

Problem: What problem is this initiative trying to address?

Solution Summary: What is the proposed solution? What do you see as its most promising aspects for creating shared value?

Impact: What is the impact of the work to date? Specify both the social and the environmental impact of your work

Financial sustainability plan: How is this initiative financially supported? How will you ensure its financial sustainability long-term?

Unique value proposition: What makes your initiative innovative? How does your project differ from other organizations working in the same field?

Founding story: Share a story about the "Aha!" moment that sparked the beginning of this initiative.

Where did you hear about the Nestlé Creating Shared Value Prize?

• Upon recommendation from others

Program Design Clarity: We are hungry to know more about what exactly your model consists of. Succinctly list a) what main activities are you doing with your beneficiaries, b) where you carry out the activities? c) how often? d) for how many hours? e) who delivers the services? and f) any other brief details

Focus area

• Rural Development

We are interested in learning more about your initiative's broad impact on sustainable development. Please reply ONLY to the question(s) related to your above focus area.

Creating shared value: How does your initiative create value for different stakeholders?

How is your initiative funded, now and over the next 5 years?

How do you plan to influence your field of work if you are a winner of this edition of the CSV Prize?

How will you leverage an investment from Nestle to expand the impact of your work?

Spread Strategies: Moving forward, what are the main strategies for scaling impact? What’s the projected impact for the coming years? Are you planning to expand your programme into new locations? On what assumptions do you build your scale-up plans?

Team: What is the current composition of your team (types of roles, number of full-time vs. part-time staff, board members, etc.)? How will this team evolve as your initiative grows?

Awards: What awards or honors has the initiative received?

Organizational leadership: How are you influencing your field of work in the present?

Should you be successful, please confirm your availability to attend the Ashoka Impact Boot camp and Creating Shared Value Prize Live Pitch Event at the World Water Forum 13-16 March 2018

• Yes, I am available to attend the events on 13-16 March 2018