1. Idea or Product Name (maximum 5 words) *
2. Associated Organization/s (is there a company, university or other organization involved in this idea/product?) *
3. Country of origin (where is the idea being developed?) * Select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia & Herzegovina Botswana Brazil British Virgin Is. Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep. Chad Chile China Colombia Comoros Congo, Dem. Rep. Congo, Repub. of the Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia, The Gaza Strip Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Fed. St. Moldova Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria N. Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts & Nevis Saint Lucia St Pierre & Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Is Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands Wallis and Futuna West Bank Western Sahara Yemen Zambia Zimbabwe
4. Short description of your idea/product (150 words in total) * a. What problem or unmet need does it resolve In one of the the 5 categories? b. Who will benefit most? c. What outcome / result does it deliver? d. How does it work?
5. What evidence (literature, trial data, etc.) is there to show your submission achieves the stated outcome/result? Please state your opinion of the strength of this evidence (200 words maximum)
6. What makes your submission innovative? (e.g. What is new in how it works to do its “Job”? perhaps the Technology? Science? Design? Perhaps how it engages sufferers, health care professionals, or consumers?) (150 words maximum) *
7. What makes your submission different than any other alternative ways to get the same outcome/result? e.g. does it look different? Does it work differently? Does the user have a different use experience? Is the cost different? Is where it is bought different? Is the maintenance different? (150 words maximum) *
8. From the users/consumers point of view, how much better is your submission versus alternatives that deliver the same outcome/result? e.g. does it look better? Does it work better? Is it easier or better to use? Is the cost lower? Is it easier to buy? Is it easier to maintain? (150 words max) *
9. What makes your submission a ‘frugal innovation’? e.g. What makes this very low cost to buy and use? (150 words maximum) *
10. How much digital technology and data analytics does it use? (100 words maximum) *
11. Relevant website/publication (provide the link if available)
12. Your name *
13. Your association with the submission (e.g. are you the owner of the idea/product? The inventor? Project lead?) *
14. Your contact phone number *
15. What authority/permission do you have to submit this for an award? e.g. do you own the idea? Has the owner authorized you to make this submission? *
17. How Did You Hear About Us?
