ZMD Technology Toolkit Application Form
Thank you for your interest in submitting your product to the Zero Mothers Die (ZMD) Technology Toolkit. Our aim is to create a database of proven mobile technology-based solutions to help organizations in the field choose the right technology for their maternal health project.

Please fill out the following form with as much information as possible. We will use this form to evaluate whether your solution is a good fit for our database.

Name of company/organization *
Your answer
City and country where company/organization is based *
Your answer
Name of product that you would like to submit to the ZMD Technology Toolkit *
Your answer
Website links to company and product *
Your answer
Year of product launch *
Your answer
Country or countries where product is being implemented *
Your answer
Health area to which product applies *
Required
Detailed description of product *
Your answer
Cost of product *
If there is a complicated pricing structure for your product, please choose OTHER and provide as detailed a response as possible.
Has your product already been used by an organization in the field? *
Was it used for a specific project? *
Description of implementation(s) *
Please provide a detailed description of how your product has been implemented, where, for what purpose and for how long. If it was for a specific project, please list the organization name and name of project. Links to articles and/or studies describing the implementation are desired.
Your answer
What types of technologies does your product use or work on? *
Required
What are the minimum requirements for an organization to use your product in the field? *
Required
Name *
For follow up purposes
Your answer
Email Address *
For follow up purposes
Your answer
Links to more information about the product, implementations, studies, etc.
Your answer
Submit
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