APPLICATION FORM – B

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APPLICATION FORM B

Primary Contact Email Id*

(Please fill the same as Form A)
Name of the Project/Innovation
(Please fill the same as Form A)
ORGANIZATION DETAILS
Specify the total numbers of employees in the organisation/ number of team members working on the project as on March 31, 2020
Total number of employees*
Total number of team members*
Leadership team (Please provide details of your leadership team)*
Name Area of responsibility Brief profile
Please identify the main competitors if any and describe how they create competition for your innovation?*
If you were to win IAI Award grant, how do you plan to utilise the grant? (Please note that this is an important question for our jury & will strongly support us in evaluating the potential of your solution. Please provide as much details as possible.)*
How will winning this award impact you/your work? Why should your innovation/project be considered for the program?*
Mention any other information with respect to the Innovation that you want the jury to consider while evaluating your application. (optional)*
Is there any current litigation against the organization or its key executives regarding the entered or any other initiative? If yes, provide details.*
FINANCIAL DETAILS
Project Cost - Mention the cost involved in the implementation of the project as per the given cost below*
Technology Salary Marketing Any other
Amount Projected (2020-21) (In cr.)
Recurring expenditure of the project (specify key heads only. In the details column, please specify the cost heads such as salary costs, HR, etc.) In Lakhs*
Technology Salary HR Any other
Amount Projected (2020-21) (In cr.)
Explain the revenue model of the innovation, i.e., the source of revenue from the innovation that contributes/will contribute to the profitability of the organization or at least make the innovation self-sustainable.*
Has this innovation received a grant/funding or impact investing/angel funding? If Yes, please provide details.*
PROJECT/ INNOVATION DETAILS
What stage is your innovation at? (Please select the stage that best describes the stage of your innovation)*
- Working Prototype, not tested
- Idea
- Working Prototype, tested by less than 25 people
- Pilot testing with a group of more than 25 beneficiaries/customers
- Under mass production, post testing
- Implemented innovation
- Available for purchase by customers/Available for use by beneficiaries. Available for use by beneficiaries.
For your project to succeed and scale what are the three top priority areas of focus that you need to work on (Technology, marketing, funding, etc.) Also mention in brief, how do you plan to work on these areas?*
What is the most critical constraint to growth that your innovation faces?*
How do you plan to overcome this constraint?*
How is your innovation unique in comparison to others in your sector?
TECHNOLOGY DETAILS
Has your organisation revised/ restructured your ICT solution from the initial design phase till date?*
How is it designed to work with the intended beneficiaries? Please provide complete details on software, hardware, features, integration mechanism, services & support, development phases & pricing (if any)*
IMPACT DETAILS
How are you going to impact the life of the persons with disabilities by using this innovation?*
Describe the methodology/tool/indicators/process that you use to measure impact.*
What is the impact (or expected impact) of your project/ service/ initiative? Please demonstrate tangible & intangible socio-economic and environmental impact with details about the extent of impact- key statistics, number of beneficiaries, existing geographies, etc.*
What are some of the risks expected and what is the plan for mitigation?*
SCALABILITY
The capacity of an innovation to grow in terms of size and impact
What are the key factors of this project that makes it scalable?*
What is your scale of operation? (Number and name of cities, geographical locations in India, communities, etc.)*
Presence In*
- Less Than 5 Cities
- More Than 5 Cities
Please describe the geography this innovation currently works in and why?*
How many persons with disabilities have been impacted directly/indirectly through your innovation?*
REPLICABILITY
The capability of the innovation to be replicated across various geographies and circumstances
What are the key factors of the project that make it replicable in other cities/ states/ regions/countries/departments?*
Is your solution, a standalone project or a part of a bigger project? Please provide details*
SUSTAINABILITY
Describe where you see the project in the following time horizons and the resources required for the same
From now up to 2 years*
Milestones Planned
Select Applicable Required Resources For Time Horizon up to 2 years*
- Capital
- Technology
- HR
- Other Resources
2 - 5 years from now*
Milestones Planned
Select Applicable Required Resources For Time Horizon 2 - 5 years from now*
- Capital
- Technology
- HR
- Other Resources
More than 5 years from now*
Milestones Planned
Select Applicable Required Resources For Time Horizon More than 5 years*
- Capital
- Technology
- HR
- Other Resources
Please provide details of your proposed innovation’s sustainability plan. What are the key factors of this innovation which makes it sustainable?*

APPLICATION FORM – B

APPLICATION FORM B

ORGANIZATION DETAILS

FINANCIAL DETAILS

PROJECT/ INNOVATION DETAILS

TECHNOLOGY DETAILS

IMPACT DETAILS

SCALABILITY

REPLICABILITY

SUSTAINABILITY