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SOCIAL GOOD SUMMIT 2021
ASSISTIVE TECHNOLOGY CHALLENGE for Persons With Disabilities
Download the Application Form guide here
Download here
Please enable JavaScript in your browser to complete this form.
Personal details
Name
*
First
Last
Sex
*
Male
Female
Sex
*
Male
Female
Age
*
Address
District
*
Kailahun
Kenema
Kono
Bombali
Falaba
Koinadugu
Tonkolili
Kambia
Karene
Port Loko
Bo
Bonthe
Moyamba
Pujehun
Western Rural
Western Urban
Region
*
Eastern Region
Northern Region
North-Western Region
Southern Region
Western Area
Phone
*
Email
*
Please confirm that you are applying for?
*
Agriculture Innovation Challenge
Assistive Technology for Persons with Disability Innovation Challenge
Impact Challenge
Are you disabled?
*
Yes
No
What’s your limitation: please specify
Institution/organization (if applicable)- Are you operating as an individual, group or other entity? Please clarify:
*
How did you find out about Youth Innovation Award 2021
Websites (UNDP/UNICEF/MOYA/NAYCOM/NYS etc)
Word of mouth/email from a colleague
Radio
TV
Facebook
Whatsapp
Others
Summary/Description of your INNOVATIVE IDEA IN ASSISTIVE TECHNOLOGY
Background - Why this solution / What specific problem do you want to address?
*
What is your proposed solution?
*
What limitation (s) does your Assistive Technology Solution address?
*
Mobility and Physical Impairments
Hearing Disability
Vision Disability
Brain Disability
Others
Others, please specify......................
Development Phase – At what stage is your proposed solution?
*
Idea - Still thinking through the process
Proof of Concept – At least you’ve checked to see whether the idea will/can actually work within the local context as you expected
Prototype – You have built the first basic model of the idea/ created a sample
Experimenting – A brief test of a prototype to see functionality and what works
Minimum Viable Product – The close to market ready final product but not the final
Have you received any significant funding support (5million and above)
*
Yes
No
Yes, from whom
Any other information you would like to share? Please attach any photos if applicable
File Upload
Click or drag files to this area to upload.
You can upload up to 10 files.
Please attach photos of your work where applicable
Submit
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