YOUNG INNOVATORS COMPETITION

APPLICATION FORM The application form must be completed by following the instructions and answering all the questions as clearly as possible in English only. You can copy, paste and fill it in using a word processor of your choice. Please save it under your TitleOfSubmission.doc and send it as an attached file to young.innovators@itu.int by June 30th. If you are having difficulties contact us using the same address.

1. Biographical information please fill in the table

Name Gender Primary e-mail address Telephone number (optional) Month and Year of Birth1 Nationality Reza Syahputra Men Reza.tunyel@gmail.com 0852 6666 9192 June, 1992 Indonesia

How did you hear about the competition? From my campus website

2. Summary of Submission
Please give us a short description of your submission below. The most important qualification is your ability to describe this project within the competition's framework. Judges will be looking for the best innovative ideas that answer one of the set challenges.

2.1. Which one of our Global Challenges are you addressing? Please only select one.
I am addressing challenge number:

1. 2. 3. 4. 5. 6.

Improve employment opportunities for young people and migrant workers Reduce food and water wastage at individual and retail level Facilitate access to public services for the elderly Improve natural disaster prediction and response Improve road safety for both drivers and pedestrians Protect sensitive personal data and inspire the creation of local digital content.

1 We will verify this information if your project is selected as a winner, so you need to be able to document your month and year of birth, as well as your nationality.

2.2. Title of Submission

The title of my submission is:

Hint: The best titles are short and catchy!

2.3. Category of submission. Please choose one of the two listed below. 2.3.1. Concept: well-researched and documented ideas that have not yet been
implemented but are poised to launch

2.3.2. Start-up: on-going operations showing preliminary results (e.g. prototypes

or pilots) and in need of support to scale their impact.

The category of my submission is:

2.4. Describe your idea in a maximum of 300 words in the box below.
enter your answer here

3. Initiative and Motivation 3.1. Tell us more about yourself by answering the following questions: What makes
you a social entrepreneur? What are your most important skills, capabilities, and personality traits? How did you come up with the idea? Why is it important for you? (maximum 150 words)

enter your answer here

Hint: We would like to learn about you, your commitment to and your relationship with the initiative. Judges will focus on applicants who have the ability to deliver and are strongly committed to their initiatives.

3.2. Tell us more about the innovation of your project by answering the following
questions: How is your solution different from other existing solutions? What is the novelty? (maximum 150 words) enter your answer here Hint: Please describe how you are going to address the challenge. As innovativeness is a very important criterion of the winning submissions, we would like to learn more about what makes it unique.

3.3. Tell us more about the social impact of your project by answering the following
questions: What has been and is the projected impact (over the next 1-3 years) of your initiative? Describe how it makes a difference! (maximum 150 words) enter your answer here

Hint: Demonstrate an understanding of the social background and context of the problem and how the solution will have a positive effect on the concerned / target group. Judges will be looking for applicants with strong knowledge of the background of the issues.

3.4. Tell us more about the implementation of your project by answering the
following questions: How do you plan to go about implementing your idea? What are some of the milestones for your future development? What is the potential for growth of the idea? (maximum 150 words) enter your answer here

Hint: Judges need to get a clear idea of how you will deliver your initiative. Be concise, focus on the most important details, but leave enough space for flexibility and demonstrate you can adjust your plans to any changes in the current situation.

3.5. Tell us more about the feasibility of your project by answering the following
questions: How do you envision success for your initiative? What barriers might hinder it? How do you plan to overcome them? What momentum does your initiative have? What phase is it at and how will it advance? (maximum 150 words) enter your answer here

Hint: Being always clear on what barriers you have and knowing how to tackle these is one of the most important abilities an entrepreneur can have. Show our judges where your initiative goes and how it will get there.

3.6. Tell us more about yourself and the Young Innovators Competition by
answering the following questions: Why are you applying to this competition? How will winning the ITU Telecom Young Innovators Competition help you deliver the initiative? Which benefits are crucial for you at this stage? Why should we choose you? (maximum 100 words) enter your answer here Hint: We would like to learn more about your relationship to ITUs Young Innovators Competition.

4. Business Plan (optional; to be attached separately to young.innovators@itu.int)

This is your chance to explain your proposal in greater length. For entrepreneurs, a business plan is essential to communicate the aim of the proposed project or solution to external parties. The format is up to you - just make a convincing argument! The limit is 5,000 words; longer documents will not be accepted.

5. Presentation (optional; to be attached separately to young.innovators@itu.int)

Summarize your project in maximum of 10 slides. Use text, graphics, pictures or whatever you would use when selling your initiative to investors! You might want to use it as a tool for your pitch at the event if you are selected, so include slide notes. The limit is 10 slides; longer presentations will not be accepted.