Part I: Contact Details (fields marked * are mandatory)

1) Contact details of the person filling out this application:

Nameyour full name
Titlecompany title(or "n/a")
Companyif there's none, please put "N/A"
Phoneonly number

2) Contact details of the nominee.

Company/organization name
Year founded
Addressif there's none, please put "N/A"
Office phoneonly number
Linkedin Profile
Facebook Profile
Twitter Profile
Please specifyif choose other
4)How did you hear about us?
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PART II: Executive Summary

1) What, briefly, is your innovation? (limit to 100 words.) (Example: Displays based on light-emitting inks.)
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2) What is the current situation in the field in which your innovation appears? (limit to 100 words.). (Example: Color screens are becoming widely embedded in a range of consumer devices such as cell phones and PDAs.)
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3) What is the problem with this situation that your innovation is seeking to address? (limit to 100 words.) (Example: However, these screens are expensive and they drain batteries fast.)
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4) How does your innovation address this situation? (limit to 100 words.). (Example: By using a new technology based on light-emitting inks, displays can be made more cheaply and use less power.)
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PART III: A CLOSER LOOK (Please explain in greater detail. )

1) What is particularly novel or noteworthy about your innovation? How is your innovation different from your competitors? (limit to 200 words.) (Example: We are the only company to develop displays based on light-emitting inks and are the first to bring devices to the market.)
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2) What impact do you expect the innovation to have on its field or on other fields? (limit to 200 words.)
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3) Is the innovation a completely new technology or is it a new combination or packaging of well-established technologies? (limit to 200 words.)
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4) If your innovation is a product, when did it first appear on the market? (limit to 200 words.)
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5) An innovation should have achieved some significant milestone , such as granting of a patent, introduction on the market, significant upgrade of an existing product, etc. What milestones have been achieved since that date? (limit to 200 words.)
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6) We are interested in knowing more about the primary innovator/innovation team. Please summarize the background(s) of the primary innovator/inventor or innovation team. (limit to 200 words.)
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7) For private companies: Have you received venture-capital funding? If so, please provide details, such as names of the VC investors. (limit to 200 words.)
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Part IV: Supporting Documents.

Supporting documents are optional but suggested. Qualified documents would be research papers, examples of media coverage and testimonials from third-party sources or customers, short video presentations, etc. Upload your supporting documents here. (Maximum file size: 8M)

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