2014 Innovation Prize for Africa (IPA)

ENTRY SUBMISSION FORM

Deadline:31October 2013

Please complete this form by answering ALL questions, and providing the full description of the project, highlighting the socio-economic benefits to Africa based on the guidelines and criteria outlined in the 2014 IPA Call for Applications. A non- complete application will be disqualified.

Eligible are innovations by Africans for Africa. Thus, Africans in the Diaspora can also apply if their innovations are of significance for Africa.

HOW DID YOU HEAR ABOUT IPA PRIZE 2013? (Mandatory)

  1. Friend or Colleague
  2. News Story
  3. E-newsletter
  4. Applied last year
  5. Other: please explain
  1. GENERAL INFORMATION (mandatory)

Full name and title/positionof the applicant (candidate)

Age and gender of the Candidate(s)

Name of the institution/organization

Complete Mailing Address

Telephone and Fax

Email

City/Province

Country/State

:

Title of the project

Please indicate (only) one category you are applying for[1]:

Agriculture/Agribusiness

Environment, Energy and Water

Health and Wellbeing

ICTs

Manufacturing and Service Industry

  1. INNOVATION DESCRIPTION

Please describe your innovation: (Please limit this to 500 words. Feel free to attach additional materials if you need to provide more details.)

Please describe how advanced is your innovation with regards to its maturity: e.g.idea phase, research development phase, prototype phase, start-up phase, market phase, scaling up phaseetc.(200 words maximum)

Please describe how your innovation meets the IPA five criteria listed below: (500 words maximum for all 5 criteria)

Who is this innovation for? Who are the primary users and what is your target market segment? (300 words maximum)

Please describe why you think your project is innovative and how it might lead to breakthroughs. Also, what is your product differentiation in comparison with similar projects that might exist? (300 words maximum)

Please describe your long-term effects/impacts of your innovation on the primary users? 200 words maximum

  1. COLLABORATION/ PARTNERSHIPS & OWNERSHIP

Please describe any collaboration/partnerships involved in this innovation (include names and contact information of all collaborators). Also, please specify the ownership (failure to disclose ownership may lead to disqualification). 300 words maximum

For innovation involving collaborators, please attach:

1)Endorsement letter from the head of the institution/organization where this work was carried out.

2)Endorsement (letters) from all individuals who contributed to this work, whowould be considered as co-owner thereof. These wouldinclude supervisor(s), co-supervisor(s), principal investigator(s), assistant(s), technicians, advisor(s), student(s), etc. Their relative role and/or contribution should be indicated in the letter (s).

For innovation not involving other collaborators, please attach:

1)An endorsement/letter of supportfrom an institution or an authority with knowledge of your innovation

  1. BUSINESS PLAN & MARKETING PLAN

Do you have a Business Plan? If YES, please attach a copy. If NO, please describe your ideas and steps taken towards developing a Business Plan. (300 words maximum)

Do you have a Business Plan (BP)? If YES, please attach a copy. If NO, please describe the steps taken towards developing a Business Plan.

Do you have a Marketing Plan? If YES, please attach a copy. If NO please describe your current marketing strategy or how you would go about it? (300 words maximum)

  1. PROOF OF YOUR INNOVATION

1)Please provide evidence that your innovation exists (web addresses, links to journal articles and other publications, attachments of project activities, etc.) 200 words maximum

2)Please attach photos, video links etc. that would help visualize your innovation

  1. RECEIVING THE AWARD

Please provide the full names and titles of the persons who shall receive the Award for this innovation (ONLY if different from the applicant). If this is a team project, please indicate people who will be representing the team on the stage and their titles.

  1. AFRICAN APPLICANTS BASED IN THE DIASPORA ONLY

For all African applicants in the Diaspora, please answer the following questions:

1)Indicate your country of origin and the country of your current residency:

2)Is your innovation being carried out in Africa? If NO, please indicate how your innovation is of significance for Africa

3)Are you planning to move to the African country where your innovation is taking place? If not, who would ensure the implementation of your innovation related work on the ground?

Entry submitted by(person who completed this application form)

Name: Position:

Signature: Date:

1

[1]If you have an innovation in a different category not listed above, and you would like to submit your application, please indicate and contact the IPA Secretariat.