APPLICATION FORM
(English version)
Innovation Awards for Franco-Chinese Teams
2015 Edition Climate Solutions
Summary of items to be submitted (please tick the box to confirm that you have submitted the items):
Commitment form for Teams and Team members
Authorization form for the communication and publication of information
Team overview and structure, highlighting the team's Franco-Chinese bi-cultural aspect
Project description showing its innovative aspects
Economic viability of the Project
Environmental and climatic impacts
Usefulness of the project in social and industrial terms
Annex: Detailed CV of Team members (optional)
Commitment form for Teams and Team members
I, the undersigned ......
(Surname and forenames,......
Date and place of birth) ......
Residing at ......
(Full mailing address) ......
......
Representing the Team ______[Name of Team]
am a candidate for the
Climate SolutionsR&D Award
Climate Solutions Innovative Product Award
Climate Solutions Initiative Award
of Franco-Chinese Teams
and agree to abide by all clauses in the Terms and Conditions of the Innovation Awards for Franco-Chinese Teams.
Done in ...... on ...... 2015
Authorization form for the communication and publication of information
One form for each Team member must be completed, signed and returned with the application form
I, the undersigned ......
(Surname and forenames,......
Date and place of birth) ......
Residing at ......
(Full mailing address) ......
......
Member of Team ______[Name of Team]
am a candidate for the
Climate SolutionsR&D Award
Climate Solutions Innovative Product Award
Climate Solutions Initiative Award
of Franco-Chinese Teams
and authorize the Organizing Institution to publish all contacts, information and a non-confidential Project description, as indicated on my Team's application form, in any advertising media as part of the Innovation Awards for Franco-Chinese Teams.
Done in ...... on ...... 2015
Team overview and structure
Highlighting the team's Franco-Chinese bi-cultural aspect
Names and identities of team members as well as professional experience and skills that the Team and Team members possess
You are:
- The Team's French representative
Surname: ...... Forename(s)…......
Date and place of birth: ...... Sex: F _ M _
Nationality: ......
Home address:......
Telephone No.: ...... Mobile No.: ......
Email: ......
Or,
- The Team's Chinese representative
Surname: ...... Forename(s)…......
Date and place of birth: ...... Sex: F _ M _
Nationality: ......
Home address:......
Telephone No.: ...... Mobile No.: ......
Email: ......
You are:
A student
Employed
If you are employed, please specify:
Your current company: ......
Your position within the company :......
Education level:
_ BAC _ BTS/DUT
_ Licence 1 _ Licence 2 _ Licence 3
_ Masters 1 _ Masters 2 _ Doctorate
_ Engineer _ Other (specify):…………......
- Composition of the Team
Please indicate for each member of the Team:
French members:
Surname: Forename(s): Age: Sex: F_ M_
Education:
Institution / Year / Course taken / Degree obtained (specify the grade) / Skills/knowledge acquired(Reproduce the table as many times as there are French team members)
Chinese members:
Surname: Forename(s): Age: Sex: F_ M_
Education:
Institution / Year / Course taken / Degree obtained (specify the grade) / Skills/knowledge acquired(Reproduce the table as many times as there are Chinese team members)
Members of another nationality (if applicable)
Surname: Forename(s): Age: Sex: F_ M_
Education:
Institution / Year / Course taken / Degree obtained (specify the grade) / Skills/knowledge acquired(Reproduce the table as many times as there are team members of another nationality)
Structure that the Team is part of
Type of structure
......
Size of structure
......
Number of employees/researchers/students
Worldwide ......
China......
Turnover
Worldwide...... China......
Motivations and personal commitments of the Team and Team members
(Signature required)
Annex: detailed CVs of Team members (optional) (maximum of 1 page per CV)
Project description
(Innovative aspects)
(maximum of 3 pages of A4 in Word format, Arial 11)
You may also describe your Project in a one-minute video (Smartphone quality)
Economic viability of the Project
(maximum of 2 pages of A4 in Word format, Arial 11)
- APPLICATIONS VISEES(1/2 page Word A4 – Arial 11)
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......
......
......
......
POUR PRIX SOLUTIONS CLIMAT
- Etudes à réaliser (technologique, d’organisation commerciale, financière, juridique…)(1/2 page Word A4 – Arial 11)
......
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......
......
......
......
......
......
......
......
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Environmental & climatic impacts
(maximum of 2 pages of A4 in Word format, Arial 11)
Evidence with precise figures, illustrating the stakes in the fight against climate change corresponding to the diffusion of innovation.
Usefulness of the project
(in social and industrial terms)
(maximum of 2 pages of A4 in Word format, Arial 11)
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