Data Innovation Program Application Form
By Healthcare Data Institute
Project leader description
1. Name (Compagny or Project leader) *
Your answer
2. Type (SME, Group, Person) *
Your answer
3. Year of founding *
Your answer
4. Address *
Your answer
Town *
Your answer
Postcode *
Your answer
Country *
Your answer
5. Number of employees *
Your answer
6. Main activity *
Your answer
7. Website *
Your answer
8. Twitter account *
Your answer
9. Is your organization part of a business incubator ? If yes, state which one : *
Your answer
10. Is your organization part of an incubator // accelerator ? If yes, state which one : *
Your answer
11. Is your organization independant ? *
Contact details
12. Name of the Project leader *
Your answer
13. Position of the Project leader *
Your answer
14. Email *
Your answer
15. Mobile *
Your answer
16. Twitter account *
Your answer
Category of the project
17. Your choice (choose one of the 5 categories below) *
18. Technological maturity of the project (please tick the stages validated by your project) *
Project details
19. Name of the project *
Your answer
20. Elevator pitch (non confidential summary) *
Your answer
21. Summary of the project in a tweet (140 marks max) *
Your answer
22. Presentation of the INNOVATIVE nature (function and/or technology) of your project *
Your answer
23. Is your project a Medical Device ? *
24. Description of your target audience
Your answer
25. Team, internal skills and key partners (state your key references) *
Your answer
26. Have you defined a business model? *
Business Model
27. Describe your business model(s)
Your answer
28. Who is(are) the payer(s) of your service ?
Your answer
29. What is/are your pricing model(s)?
Your answer
Market Data Analysis
30. Have you done a market study? *
Market Data Analysis
31. Commercial maturity of the project (please tick the stages validated by your project) *
32. Sales forecast 2019 and 2020 (if applicable)
Your answer
33. First sale date of the solution
MM
/
DD
/
YYYY
34. Turnover of the company if applicable (2016, 2017, 2018)
Your answer
Benchmark
35. Do you have any competitors ? *
36. If yes, which one(s) ?
Your answer
37. What is your added value ? *
Your answer
Rewards
38. If your project is selected, which rewards would you like to get ? *
Required
Terms and conditions
Before confirming your application, please consult the Data Innovation Program's terms and conditions on our website : https://bit.ly/2FMesY9
39. Do you accept the terms and conditions ? *
Required
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