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INNOVATION

INDO PACIFIC 2022 INNOVATION PROGRAM

INDO PACIFIC 2022 Young Innovator Award

ENTRY FORM

 
1. Nominee Details:
Name:
Address:

Date of Birth:
  NOTE: The nominee must be under 30 years of age as of the date entries fall due
 

2. Nominee Citizenship:
Are you an Australian Citizen?:
   
 

3. Nominee Employer Details:
Name:
Address:
 

4. Nominator Details:
Name:
Job Title:
Employer:
Phone:
Email:
Postal Address:
 

5. Brief Description of Project on which Nominee worked:
Innovation can be described simply as something that is either new to the adopter or that changes the adopter’s circumstances and/or behaviour – and it may be a combination of all three. Please frame your description using this framework as guidance. (Attach additional pages if necessary - marked as Annexe A)
Upload Additional Information:
   

6. Nominee’s Contribution to the Project:
(Attach additional pages if necessary - marked as Annexe B)
Upload Additional Information:
   

7. Evidence of Nominee’s understanding of user needs:
(Attach additional pages if necessary - marked as Annexe C)
Upload Additional Information:
   

8. Evidence of Nominee’s Originality and Innovativeness in meeting the challenges of the project concerned:
(Attach additional pages if necessary - marked as Annexe D)
Upload Additional Information:
   

9. If successful, how will the Nominee use the cash award to advance his/her career?
 

10. Nominee Approval:
Name:
Job Title:
Date:
Acceptance:  
   
  (NB – the Nominee has the right, when approached, to decline the nomination for any reason he or she may choose. Deliberately falsifying data on the entry form will result in immediate disqualification)

 

 

 

For further information about the INDO PACIFIC 2022 Innovation Awards please contact:

Gregor Ferguson
Executive Manager Innovation and Industry Engagement
AMDA Foundation Limited
PO Box 4095
GEELONG VIC 3220

Tel: +61 (0)414 803 717
Email: gferguson@amda.com.au