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    YOUNG INNOVATORS COMPETITION

    APPLICATION FORM

    The application form must be completed by following the instructions and answering all thequestions 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 itas an attached file to [email protected] by June 30th. If you are having difficulties

    contact us using the same address.

    1. Biographical information please fill in the table

    Name Reza Syahputra

    Gender Men

    Primary e-mail address [email protected]

    Telephone number (optional) 0852 6666 9192

    Month and Year of Birth1 June, 1992

    Nationality 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. Improve employment opportunities for young people and migrant workers

    2. Reduce food and water wastage at individual and retail level3. Facilitate access to public services for the elderly

    4. Improve natural disaster prediction and response5. Improve road safety for both drivers and pedestrians

    6. 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 beable to document your month and year of birth, as well as your nationality.

    mailto:[email protected]:[email protected]:[email protected]:[email protected]
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    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 beenimplemented but are poised to launch

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

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    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 impactof your projectby answering the followingquestions: What has been and is the projected impact (over the next 1-3 years) ofyour 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 thebackground of the issues.

    3.4.Tell us more about the implementation of your projectby answering thefollowing questions: How do you plan to go about implementing your idea? What aresome 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 feasibilityof your project by answering the followingquestions: How do you envision success for your initiative? What barriers mighthinder 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

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    Hint: Being always clear on what barriers you have and knowing how to tackle theseis 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 Competitionbyanswering the following questions: Why are you applying to this competition? Howwill winning the ITU Telecom Young Innovators Competition help you deliver the

    initiative? Which benefits are crucial for you at this stage? Why should we chooseyou? (maximum 100 words)

    enter your answer here

    Hint: We would like to learn more about your relationship to ITUs Young InnovatorsCompetition.

    4. Business Plan (optional; to be attached separately to [email protected])

    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 [email protected])

    Summarize your project in maximum of 10 slides. Use text, graphics, pictures or whateveryou 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.